Remote RN Utilization Management Specialist
McLaren Health Care
- Remote job
McLaren Health Care is seeking a Registered Nurse to join the Utilization Management team. The role focuses on determining appropriate patient status, ensuring medical necessity, and documenting care for insurance and government payers within an acute care hospital context. You will collaborate with admitting physicians and care teams, conduct concurrent reviews, and support discharge planning while maintaining compliance with payer requirements and clinical guidelines. #J-18808-Ljbffr McLaren Health Care
- ...Cleveland Clinic is seeking an Utilization Management RN Reviewer to support remote operations from home. The role covers admission and concurrent reviews, and ensures medical necessity criteria are applied to hospital stays and discharges. Qualifications include RN...Remote work
- ...Logan Health is hiring a Utilization Management Specialist to join the UM team. The role focuses on reviewing admissions, validating documentation... ...communication and EMR proficiency, with a four-day work week and remote options for Montana residents. #J-18808-LjbffrRemote work
- ...Logan Health Medical Center is seeking a Utilization Management Specialist to review admissions across the... ...appropriate status. This role suits an RN or Social Worker with acute care experience... ...insurers. The position is fully remote for Montana residents and offers a...Remote work
- ...Health is seeking an experienced Registered Nurse to support utilization management and care coordination from a remote work setup within the United States. Candidates should have 2+ years of acute/critical care RN experience and an active RN license in their state of...Remote work
- ...CVS Health Corporation seeks an experienced Registered Nurse (RN) to support 24/7 Utilization Management operations. You will review cases, assess medical necessity, coordinate care, and ensure members receive appropriate, high-quality healthcare services. Join a dynamic...Remote workWork from home
- ...talented, compassionate people are united in bringing the most advanced care to our neighbors throughout the region. Organization Utilization Management Job Summary Facilitates optimal reimbursement through accurate certification and complete chart documentation ensuring that...Remote workTemporary workWork experience placementLive outFlexible hours
- ...seeking a Registered Nurse to support utilization management and care coordination. You will assess... ...and care teams. Ideal candidates hold an RN license with 2+ years in acute/critical... ...quiet home office setup will be expected for remote work. #J-18808-Ljbffr CVS HealthRemote workHome officeWeekend workAfternoon shift
- ...UnitedHealth Group is seeking a qualified RN for utilization management in Hawaii. The role offers the flexibility to work remote while handling complex clinical and non-clinical determinations and documentation. You will assess needs, interpret records, and collaborate...Remote workShift work
- ...a partner company seeking a Clinical Denials Management Specialist based in the United States. The role is fully remote and focuses on reviewing, appealing, and preventing... ...a healthcare system, working with nursing, utilization management, revenue integrity, and patient...Remote work
- ...Cleveland Clinic Health System is seeking an experienced Utilization Management RN Reviewer to work remotely with a focus on admission, concurrent and retrospective reviews. The role supports payer communications, data collection, and clinical decision-making to ensure...Remote workWork at office
$69.39k - $88.61k
...Cincinnati Children’s is seeking an experienced Utilization Review professional for a remote role in the United States. The position supports case management, authorization, compliance, and... ...s degree in a related field, an active RN/Social Work/Clinical Counselor license,...Remote workFull time- ...WNS, part of Capgemini, seeks a remote Utilization Review Nurse to perform medical necessity reviews and collaborate with providers to ensure... ...strong team-oriented environment. Requirements include active RN or LVN licensure, a minimum of two years in utilization review...Remote workWork at office
- ...Saint Joseph Health System is seeking an RN Utilization Review specialist for a part-time, remote PRN role that requires on-site training in Mishawaka, Indiana. The position emphasizes reviewing medical necessity, insurance requirements, and discharge planning in collaboration...Remote workPart timeRelief
$65k - $85k
...Concierge Home Care | Remote Opportunity | Growth Opportunities | Increased Earning... ...and looking for an experienced Utilization Review Specialist (RN) to join our remote home health team... ...Collaborate with Branch Directors, Clinical Managers, and field clinicians Support...Remote workMonday to FridayWeekend workWeekday work- ...Cambia Health Solutions seeks a UM IP Clinical Specialist to support inpatient utilization management by researching requests, coordinating with licensed clinicians, and ensuring accurate case documentation and timely actions.The role emphasizes collaboration with clinical...Remote work
- ...Cedars-Sinai is seeking an Utilization Management Specialist to provide advanced operational support for the UR team. You will manage an assigned portfolio of cases, assemble and review documentation, and coordinate payer submissions to ensure timely and compliant authorizations...Remote work
- ...Cedars-Sinai is seeking an Utilization Management Specialist to provide advanced operational support for UR Nurses, ensuring timely, accurate, and compliant utilization reviews. The role handles authorization workflows from submission to final determination and collaborates...Remote work
- ...Cedars-Sinai is seeking an Utilization Management Specialist to provide advanced support for the utilization review process. You will manage an assigned portfolio, assemble documentation for payer submissions, and ensure timely determinations while maintaining compliance...Remote work
- ...Cedars-Sinai is seeking an Utilization Management Specialist to provide advanced operational support for UR Nurses and ensure timely, compliant authorization workflows. You will manage case portfolios, coordinate documentation, and interact with payers to prevent denials...Remote work
- ...Providing advanced operational support, the remote California Utilization Management Specialist will manage authorization workflows, ensure compliance with regulatory standards, and facilitate communication with payers while collaborating with UR Nurses and other departments...Remote work
- ...Providence California Regional Services is seeking a Senior Utilization Management Assistant for a REMOTE, per diem role with 8-hour variable shifts. Reporting to the Regional Director of Care Management, you will support the care management team in coordinating patient...Remote workDaily paidShift work
- ...Providence California Regional Services seeks a Senior Utilization Management Assistant to support the Care Management team. This REMOTE, part-time role offers 8-hour Evening shifts under the supervision of the Regional Director of Care Management. You will perform...Remote workPart timeAfternoon shift
- HonorHealth in Phoenix is seeking an Utilization Review RN Specialist to review and monitor utilization, ensuring medically necessary care and appropriate... ...candidate has an RN license with 1 year UR/UM or Case Management experience and 3 years RN in acute care, with strong...Remote job
$80k - $150k
...Asset Management SpecialistOrbital Engineering, Inc. is currently seeking an Asset Management Specialist with experience in CASCADE and ELECTRIC UTILITIES for a REMOTE WORK role for our Utility Services team to support the implementation of DNV Cascade 4 utility asset...Remote workTemporary workWork at officeWork from home- ...Brigham Health Plan is seeking a skilled RN to support vendor-related... ...ensure effective collaboration between the Utilization Management (UM) department and vendors. The position... ...requires on-call availability monthly and a remote work setup with occasional onsite meetings...Remote jobMonday to Friday
- HonorHealth is seeking an Utilization Review RN Specialist to review and monitor the utilization of health care services, ensuring medical necessity... ...from admission onward. You will work with the Care Management team to address documentation issues, support data reporting...Remote job
- ...Best Hospitals. What You Will Do in This Role: The Utilization Management Specialist provides advanced operational and workflow support to Utilization... ...information is current and complete. *Approved Remote States: Arizona, California, Colorado, Florida, Georgia,...Remote work
- ...Trillium Health Resources is seeking an Utilization Management Specialist III - MH/SU to perform comprehensive clinical review of service requests... ...Carolina licensure; travel within the NC catchment is expected. Remote work options are available for many roles. #J-18808-...Remote work
$37.5 - $54.25 per hour
...Expertise to Logan Health’s Utilization Management Team! Our Mission: Quality,... ...for a Utilization Management Specialist to join our dedicated team!... ...This position is ideal for an RN or Social Worker with strong... ...person-centered care! Fully remote opportunity - Must currently...Remote workFull timeImmediate start10 hours per weekShift workRotating shiftWeekend workDay shiftAfternoon shift$114k - $161k
...Principal Consultant - Utility Return on Equity & Cost of Capital Specialist Job Title: Principal Consultant – Utility... ...: Hybrid – 3 days in office, 2 remote days per week 2025 Salary Range... ...") is an employee‑owned leading management consulting and financial advisory...Remote workWork at officeWork from homeFlexible hours2 days per week
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