Remote Utilization Management Nurse (RN)
Cambia Health
Salem, OR
- Remote job
Cambia Health is seeking an Utilization Management Nurse who can conduct prospective, concurrent, and retrospective reviews to ensure medical necessity and proper care pathways. You will apply evidence-based criteria and consult with physicians as needed. In this role, you will collaborate with case management and other departments, support transitions of care, and maintain compliant, accurate documentation while serving members, providers, and regulatory bodies. #J-18808-Ljbffr Cambia Health
Vacancy posted 2 days ago
Similar jobs that could be interesting for youBased on the Remote Utilization Management Nurse (RN) in Salem, OR vacancy
- ...Job Summary: As an on-site Hospital Utilization Management (UM) Nurse, you are the primary link between the... ...administrative compliance. Unlike remote roles, this position relies heavily on... ...site UM Nurse is a Registered Nurse (RN) responsible for performing admission...Remote workFull timeImmediate startShift work
- ...Arkansas Blue Cross Blue Shield is seeking an Utilization Management Nurse to perform clinical reviews of prior approvals, network exceptions, and... ...inpatient/outpatient procedures. The role requires an active RN license and a Bachelor's degree is preferred, with at least...Remote workWork from home
- ...Humana is seeking a Utilization Management Nurse 2 to apply clinical nursing skills in coordinating and documenting medical services and benefit determinations... ...has an Associate Degree in nursing, an active compact RN license, and at least three years of geriatric care...Remote work
- Utilization Management Nurse at Cambia Health Solutions, Inc. works from home across Oregon, Washington, Idaho or Utah, with preference for Idaho/ Utah residents. The role performs prospective, concurrent and retrospective reviews to ensure medical necessity and appropriate...Remote jobWork from home
$70k - $75k
Utilization Management Registered Nurse (RN) - Remote Full-time WHO IS GUIDEHEALTH? Guidehealthis a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients...Remote workBi-weekly payFull timeTemporary workFor contractorsLocal areaWork from home- ...Work Shift As an on-site Hospital Utilization Management (UM) Nurse, you are the primary link between the... ...and administrative compliance. Unlike remote roles, this position relies heavily... ...site UM Nurse is a Registered Nurse (RN) responsible for performing admission...Remote workImmediate startShift work
- Inland Empire Health Plan (IEHP) is seeking an experienced Utilization Management Nurse to perform prospective, concurrent and retrospective reviews ensuring medical necessity and alignment with UM criteria. Under the UM Manager, you will collaborate with Medical Directors...Remote job
- Integrated Home Care Services (IHCS) seeks a Utilization Management Nurse to ensure home health services are delivered with quality, cost efficiency... ...to optimize patient outcomes. State licensure as an LPN or RN and a minimum of 2 years in Utilization Management are...Remote job
$38 - $40 per hour
...Title: RN -- Review Analyst Location: Remote Duration: 12 months with possible extension... ..., and retrospective utilization reviews for inpatient,... ...background includes Utilization Management (UM) , Case Management... ...- Bachelor's degree in Nursing or a related field...Remote workHourly payWork at officeMonday to FridayShift work- ...Cambia Health Solutions, Inc. is seeking an Utilization Management Nurse to perform prospective, concurrent, and retrospective reviews for member... ...and coordinating with care teams. Ideal candidates hold an RN license with 3+ years in case or utilization management, and...Remote workWork from home
- Yoh is seeking a Utilization Management Nurse Coordinator (RN or LVN) for a 6+ month remote contract with a managed care client based in Northern California. Training occurs onsite in Fairfield or Redding for three weeks, then transitions to fully remote. The role reviews...Remote jobContract work
- ...authentic experience! Under the general direction of the Utilization Management Manager, the Utilization Management Nurse is responsible for prospective and concurrent/... ...in an acute care facility utilizing an active RN license is required. Experience in an HMO or experience...Remote jobTemporary workFlexible hours
$72.8k - $130k
...scheduling and there is an occasional opportunity for remote work based on business needs. As a Sr Utilization Management Nurse in the Springfield MA Regional Area, the role... ...: ~ Must be a Registered Nurse (RN) with a current, active, unrestricted RN License...Remote workMinimum wageFull timeWork experience placementCasual workLive inWork at officeLocal area- ...CVS Health is seeking an Utilization Management Nurse Consultant to assess and coordinate care for members... ...continuum of care. This role requires RN licensure, 2+ years in acute/critical... ...effective communication. A BSN is preferred; remote work is supported within the state(s)...Remote work
- ...Alignment Health is seeking an inpatient review nurse to join our remote utilization management team. You will collaborate with the patient’s physician, facility... ...at the right level. Requirements include a CA LVN/RN license, minimum 3 years in case management,...Remote work
- ...Cambia Health is seeking an Utilization Management Nurse who can work remotely within the U.S. states of Oregon, Washington, Idaho or Utah. The role focuses on... ...years of case/ utilization management experience, an RN license (or equivalent), and a health/human services degree...Remote work
- ...A healthcare staffing agency is seeking a Utilization Management RN to work remotely from PA, DE, or NJ. The role involves assessing clinical information, determining medical necessity for services, and collaborating with providers. Candidates should have at least three...Remote workFlexible hoursWeekend workDay shift
- Cambia Health is seeking an Utilization Management Nurse to support prospective, concurrent and retrospective reviews from a home-based role across... ...coordinating with physicians and care teams. The role requires an RN with 3 years of case management or related UM experience,...Remote jobWork from home
- ...Cambia Health is hiring an Utilization Management Nurse to support care decisions remotely in OR/WA/ID/UT with opportunities for Idaho or Utah residents. The role emphasizes clinical review, evidence-based criteria, and collaboration with care teams. The position requires...Remote work
- ...CVS Health is seeking an experienced Registered Nurse (RN) to join the Utilization Management team in a remote capacity. You will review clinical information to support coverage determinations and apply evidence-based criteria across the continuum of care. The role...Remote work
- ...Cambia seeks an Utilization Management Nurse to work remotely from OR, WA, ID or UT with preference to current employees and residents of Idaho and Utah. You will perform prospective/concurrent/retrospective reviews to promote quality and cost-effective care while ensuring...Remote work
- ...Cambia Health Solutions, Inc. is seeking an experienced Utilization Management Nurse to conduct prospective, concurrent, and retrospective reviews and apply clinical criteria to determine medical necessity. You will collaborate with physician advisors to support appropriate...Remote work
- ...Humana Inc. is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation and determinations for medical services and benefit administration.You will report to the Manager of Utilization Management and serve as a member of the...Remote work
- Cambia Health is seeking an Utilization Management Nurse to support care decisions from a home-based setup across several states, including Washington, Oregon, Idaho and Utah. The role emphasizes clinical judgment, cost-effective care, and policy-based reviews. The nurse...Remote jobWork from home
$26.01 - $68.55 per hour
CVS Health is seeking a Registered Nurse (RN) for Utilization Management. You will review clinical information to support coverage determinations, apply... ...to ensure appropriate care. This full-time role offers remote work from home in the United States, with a 40-hour...Remote jobHourly payFull timeWork from home- ...Cambia Health is seeking an Utilization Management Nurse to perform prospective, concurrent, and retrospective reviews within a remote-capable role serving eligible states. You will apply evidence-based criteria to determine medical necessity, collaborate on care transitions...Remote work
- ...Curana Health seeks an experienced Utilization Management Nurse to review and monitor members’ use of healthcare services, ensuring high-quality... ...discharge planning, and high-dollar claims analysis, with remote telephonic duties and occasional weekend coverage. The...Remote work
- A healthcare recruitment firm is seeking a Lead Healthcare Recruiter (Utilization Management RN) for a remote 6-month contract. The ideal candidate will have an active RN license and experience with health plan operations. Responsibilities include evaluating healthcare...Remote workContract work
- ...Arkansas Blue Cross and Blue Shield is seeking an experienced Utilization Management Nurse (RN) to perform clinical reviews of prior approvals, network... ..., evidence-based care, and cost containment with a remote work option across multiple states. The ideal candidate...Remote work
- Cambia Health Solutions, Inc. is hiring a Utilization Management Nurse who will conduct reviews to ensure medical necessity and cost-effective outcomes. Working from home within the states of Oregon, Washington, Idaho or Utah, you will assess patient needs and collaborate...Remote jobWork from home
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Utilization Management Nurse (RN). Be the first to apply!



