Remote Utilization Management Nurse: Appeals & Reviews
Registered Nurse
- Remote job
Optum is seeking an Utilization Management Nurse to review patient records and craft defensible appeal letters. The role requires an RN license, 3+ years bedside experience, and strong data extraction skills. You will work per diem with flexible start times and may telecommute from anywhere in the United States. Responsibilities include HIPAA compliance, collaboration with OPAS/Optum teams, and maintaining high quality reviews. Microsoft Office proficiency and 45 wpm typing are required. #J-18808-Ljbffr Registered Nurse
- ...To support a centralized Utilization Management department, the full-time Utilization Review Nurse will conduct timely utilization... ...regulatory requirements while working remotely. Key responsibilities:... ...Previous Utilization Management, Appeals, or Denials Management...Remote workFull time
$29 - $52 per hour
Optum is seeking an Utilization Management Nurse to review patient records, extract essential details, and craft defensible appeal letters following process guidance. The role emphasizes HIPAA compliance and timely, high-quality reviews. The position offers Per Diem scheduling...Remote jobHourly payDaily paidFull timeFlexible hours- ...Hospital is seeking an experienced RN/LPN to perform remote clinical reviews for appeal cases. You will review medical records, apply... ...and 3+ years in a clinical setting plus 1 year in managed care or utilization management. This is a 7-month contract with potential...Remote jobContract work
$65.8k - $130.8k
Onsite or Remote Flexible Hybrid Work Schedule Monday... ...The UM Denial Nurse Reviewer supports high-quality, cost... ...required Two or more years of utilization review/utilization management experience in an HMO,... ...scoring Knowledge of the appeals process Experience with...Remote workMonday to FridayFlexible hours- ...Job TitleRegistered Nurse (RN) for Critical Incident Management TeamLocationHarrisburg... ...will be responsible for reviewing and evaluating... ...participate in hearings, appeals, and stakeholder discussions... ...environment while utilizing technology to support remote and hybrid work...Remote workWork from home
- ...States is seeking an Inpatient Utilization Management Clinician to evaluate... ...across care teams. This fully remote, full-time role requires an active RN license, nursing degree, and experience with InterQual... ...management to ensure timely reviews, document outcomes, and...Remote workFull time
- ...TriWest Healthcare Alliance seeks a Utilization Management Clinical Review nurse to evaluate and authorize beneficiary care, focusing on cost-effective, appropriate utilization of Behavioral Health and Medical/Surgical services. Responsibilities include preauthorization...Remote work
- ...Description Job Description The utilization review and management (UM) component program ensures that external... .... Qualifications ~ Registered nurse with active, unincumbered nursing... ...lunch This is an in-office, no remote work capability position Travel...Remote workWork at office
- ...organization dedicated to improving health outcomes through care and technology. The Utilization Management Nurse will extract details from patient records and craft persuasive appeal letters per guidelines, within required timeframes. The role offers Monday-Friday, 40...Remote jobMonday to FridayFlexible hours
$59.5k - $116.6k
UnitedHealth Group is seeking a Utilization Management Nurse RN to work remotely from anywhere in the U.S. This role involves ensuring efficient health services and requires an active RN license and 3+ years of Managed Care or Clinical experience. The successful candidate...Remote jobWeekend work$60.2k - $107.4k
...services company focused on improving health outcomes through innovative care and technology. The Utilization Management Nurse will review patient records and craft defensible appeal letters per guidelines while adhering to HIPAA and company policies. The role offers a...Remote jobFull timeMonday to Friday$72.8k - $130k
...occasional opportunity for remote work based on business needs. As a Sr Utilization Management Nurse in the Boston MA Regional Area... ...to discuss care details, reviewing clinical information for appropriateness... ..., and/or clinical appeal and guidance reviews ~ Must...Remote workMinimum wageFull timeWork experience placementCasual workLive inWork at officeLocal area- UnitedHealth Group's Optum unit seeks a Utilization Management Nurse to review medical records and craft defensible appeal letters with attention to HIPAA and policy requirements. The role emphasizes timely, high-quality reviews of cases. The position offers a 40-hour...Remote jobMonday to Friday
- UnitedHealth Group is seeking a Utilization Management Nurse to review medical records and craft defensible appeal letters. The role supports telecommuting from anywhere in the U.S. and requires a state RN license, 3+ years bedside nursing, and strong data extraction skills...Remote job
$60k
...LPN/LVN Utilization Management Nurse Integra is looking for a LPN/LVN experienced in the managed... ...service and post-service utilization reviews and appeals for DMEPOS. This individual will... ...Career development opportunities Remote Opportunities We are actively...Remote workTemporary workLocal area$95k - $110k
Select how often (in days) to receive an alert: DRG Nurse Reviewer Appeals and Hearings- Remote Date: Aug 30, 2026 Location: Any city, FL, US, 99999... ...hearings in conjunction with the Medical Director. Assists management with training new reviewers to include daily...Remote jobFull timeWork from homeRelocation packageFlexible hours- A global talent management firm is seeking a Utilization Review Nurse for a contract role based in Pennington, NJ. The role involves performing utilization management, reviewing medical records, and coordinating discharge planning. Candidates must have an active RN license...Remote jobContract work
- ...Job Description Join our team as a remote full time days and every other weekend RN Case Manager -Utilization Review at INTEGRIS Health, Oklahoma City, OK. Get to... ...Association within 30 days of hire RN (Registered Nurse) Current licensure as a Registered Nurse (RN)...Remote workFull timeWork at officeWeekend work
- Currently seeking a Utilization Management RN . Please see details and qualifications below: Position is remote - candidate must reside in the tri... ...an active PA license or a Nurse Licensure Compact to include... ...conditions through medical record review to determine medical...Remote workImmediate startDay shift
- ...CVS Health is seeking an experienced Utilization Management (UM) Nurse Consultant to join our remote team. This 100% work-from-home role serves members across the... ...appropriate care and timely approvals. You will review clinical documents, collaborate with providers,...Remote workWork from home
$45 - $50 per hour
Join Our Team as a Utilization Management RN - Make an Impact in Healthcare Are... ...you a dedicated Registered Nurse passionate about optimizing... ...outcomes. Whether working remotely or in a flexible hybrid... ...you'll play a key role in reviewing authorization requests, evaluating...Remote workHourly payWork at officeFlexible hours- ...Registered Nurse (RN) | Utilization Review Location: Pennsylvania Agency: Pyramid Consulting,... ...Position Key Responsibilities ~100% REMOTE role but candidate has to be in (PA,... ...be provided ~ Perform utilization management reviews for inpatient admissions...Remote workWeekly payFull timeImmediate start
- ...Hopkins Health Plans (JHHP) is the managed care and health services business of... ...hours are 8:00 AM - 5:00 PM As a Utilization Review Registered Nurse for Johns Hopkins Health Plans, you... ...~ Work-life balance - This is a remote role! Candidates in the following approved...Remote workFull timeMonday to Friday
- ...A peer review organization is seeking a full-time remote Utilization Management Physician Reviewer. Ideal candidates must hold an MD, DO, or DPM degree with active board certification and unrestricted medical license in relevant states. The role involves performing detailed...Remote workFull timeWork from home
$38 - $45 per hour
...Registered Nurse (RN) | Utilization Review Location: Fort Myers, FL Agency: Lancesoft Inc... ...Registered Nurse – Utilization Review (Remote) Location: Fort Myers, Florida... ...Center Department: Utilization Management Contract: 13 weeks with possible...Remote workHourly payFull timeContract workWork experience placementMonday to FridayShift workWeekend work$34 - $47 per hour
...Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services Department... ...various Health Plans. This is a remote position for CA-licensed nurses. Candidates... ...one year of outpatient Utilization Management experience in a fast-paced setting....Remote workHourly payLive inWork at officeMonday to FridayShift work- ...primary care, wellness, disease management and population health... ...the U.S. achieving Magnet nursing excellence designation for... ...mission. Job Summary The Utilization Management Review Nurse (UMRN) performs... ...reconsiderations, assist with appeals as needed and arrange peer...Remote workWork experience placementWork at officeFlexible hoursWeekend work
$50k
...Industry: Behavioral Healthcare Management Why consider this job... ..., concurrent reviews, and internal utilization review assessments Consult... ...coordinate urgent/expedited appeals Staff individual cases... ...license (e.g., Registered Nurse, Licensed Practical Nurse,...Remote work$2,065 per week
...Cross Country Nurses is seeking a travel nurse RN Utilization Review for a travel nursing job in Fort Myers, Florida. Job Description... ...Extension (UR EXT) specialist for a remote position. This role involves conducting utilization management activities, requiring collaboration...Remote workTemporary workFor contractorsZero hours contractMonday to FridayShift workWeekend work- ...Description Job Description: Manager of Clinical Utilization Management - Denial... ...Type: Hybrid (85% remote, 15% onsite in... ...tasks, performance reviews, and any necessary disciplinary... ...Registered Nursing Program; RN... ...prior-authorization, appeals & grievance, or health...Remote workPermanent employmentFull timeTemporary workFlexible hours
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