Remote Utilization Management RN - Path to CM
WPS—A health solutions company
- Remote job
WPS, a health solutions company, is seeking an Utilization Management RN to evaluate medical necessity and authorize services for our Health Plan. The role includes referring cases to medical directors and potential cross-training into Case Management, with growth toward a combined UM/CM position in the future. The position offers remote work with approved states and a strong emphasis on quality care, cost control, and collaboration with Medical Directors and Health Services teams. #J-18808-Ljbffr WPS—A health solutions company
- ...a health solutions company, is seeking an Utilization Management RN to assess medical necessity, authorize services... ...with medical directors. The role offers remote work in multiple states and a potential path toward combined UM/CM responsibilities. There is a strong...Remote jobCms
$75k - $100k
WPS Health Solutions is seeking a Utilization Management Registered Nurse to evaluate efficiency, appropriateness, and medical... ...with potential growth into a combined UM/CM position. The position offers remote work options in multiple states, including Texas, with...Remote jobCms- WPS Health Solutions seeks an Utilization Management RN to evaluate medical necessity and appropriateness... ...extended hospital stays. We support remote work in multiple states and offer opportunities to grow into a combined UM/CM role. #J-18808-Ljbffr WPS Health SolutionsRemote jobCms
$75k - $100k
WPS Health Solutions is seeking a Utilization Management Registered Nurse to evaluate medical necessity and appropriateness of... ...Management and potential growth into a combined UM/CM position. The position offers remote work in approved states, a salary range of $75,000-...Remote jobCms- WPS Health Solutions seeks an experienced Utilization Management Registered Nurse (UM RN) to evaluate efficiency, appropriateness, and medical necessity for... ...Case Management with potential growth into a combined UM/CM position and future CM opportunities. The candidate...Remote jobCms
- Clover Health is seeking a Lead RN, Utilization Management, to coach clinical staff, oversee daily review operations, and ensure timely, accurate determinations that align with benefits, clinical criteria, and CMS requirements. You will partner with Medical Directors and...Remote jobCms
$70.2k - $120.4k
...norm and every member feels valued.The Utilization Review RN will review and document member case... ...revision of medical policies and utilization management and/or clinical appeals policies.... ...RN license requiredThis position is a Remote role. To be eligible for consideration...Remote workCmsWork experience placement- Central California Alliance for Health is seeking a Prior Authorizations Nurse (RN) for a temporary, full-time role. This remote-in-California position reports to the Utilization Management Supervisor and involves ensuring PA requests comply with contracts and evidence-...Remote jobCmsFull timeContract workTemporary work
$35 - $40 per hour
Sagility is hiring an RN Utilization Management Reviewer to perform day-to-day clinical and service authorization reviews for medical necessity,... ...and 2+ years in a clinical setting; CCM a plus. This fully remote US-based role offers competitive benefits, M-F 9:00-5:30 ET...Remote jobCmsHourly payShift workWeekend work$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... ...Qualifications: ~ Must be a Registered Nurse (RN) with a current, active, unrestricted RN License...Remote workCmsMinimum wageFull timeWork experience placementCasual workLive inWork at officeLocal area$52 - $56 per hour
...Contract RN For New York Health Plan You've done UM. You've worked appeals. Now find a role that uses both. We're... ...ll apply the same medical necessity judgment you built in utilization management. 100% remote (U.S.) | Contract | $52$56/hr based on experience Business...Remote jobCmsContract workAfternoon shift- ...Description Join our team as a remote (Oklahoma City) full time days and every other weekend RN Case Manager -Utilization Review at INTEGRIS Health, Oklahoma City, OK. Get to Know Your Team: INTEGRIS Health, Oklahoma's largest not-for-profit health system, is seeking...Remote workCmsFull timeWork at officeWeekend work
- ...Utilization Management RN (Registered Nurse)Our Utilization Management RN (Registered Nurse) evaluates... ...to cross-training in Case Management (CM), with the potential for the role to grow... ...experience. Work Location We are open to remote work in the following approved states:...Remote workCmsFor contractorsWork at officeImmediate start
$143.68k - $185.81k
...UCLA Medical Group Utilization Review Nurse Under the direction of the Assistant Director, the Intensive Case Management Medicare Advantage Utilization Review Nurse performs utilization... ...in utilization management, Inpatient CM or clinical Experience. Strong knowledge...Remote jobCmsWork at officeFlexible hours$81.95k - $110.24k
...provider of technology-enabled revenue cycle management solutions for health systems,... ...the possible in healthcare. The Lead Utilization Review RN is a key contributor to the overall financial... ...degree Nursing required #LI-LS1 #LI-REMOTE Join an award-winning company...Remote workCmsFull timeWork at officeLocal area$85.7k - $129.31k
...Job Description: The RN Utilization Review Care Management I leverages clinical expertise and critical thinking to perform utilization review care management... .... Experience working successfully working in a remote environment or using Advanced Microsoft Suite, including...Remote workCmsHourly payReliefWork at officeFlexible hoursShift workWeekend work2 days per week- ...an authentic experience! Under the general direction of the Utilization Management Manager, the Utilization Management Nurse is responsible for... ...care experience in an acute care facility utilizing an active RN license is required. Experience in an HMO or experience in a...Remote jobCmsTemporary workFlexible hours
$63.1k - $94.65k
...technology-enabled revenue cycle management solutions for health systems,... ...*Must have current compact RN license, or be willing to... ...coverage We are seeking Virtual Utilization Review Specialist with at... ...Required: ~ This is a remote role which requires access to...Remote workCmsFull timeTemporary workWork at officeLocal areaMonday to FridayShift work$35 - $40 per hour
...through service offerings for clinical, case management, member engagement, provider solutions,... ...containment, and analytics. Job Title RN Utilization Management Reviewer Responsibilities... ...may require weekends. Location: Fully remote work at home role. Secure, private area...Remote workCmsHourly payTemporary workMonday to FridayFlexible hoursWeekend work- ...Utilization Management Coordinator This position is responsible for coordinating... ...degree and active NYS RN license required. Bachelors degree... ...multiple areas (i.e. UM and CM). Incumbent is required to know... ...note: The opportunity for remote work may be possible for all...Remote workCmsContract workWork at office
- ...DescriptionJob DescriptionJob Description: Ascension Texas Utilization Management Department (Fully Remote)Job Summary:" Provides health care services regarding... ...(Allscripts)Required Skills/Experience: Licensed RN (multistate or TX RN), 2 years acute care UM experience...Remote workCms
- ...Utilization Management Nurse The primary role of the Utilization Management Nurse is to review and... ...nursing facility. This is primarily a remote telephonic position with normal business... ...Minimum 2 years clinical experience as RN, LPN/LVN required. Minimum 1-year managed...Remote workCmsContract workWork at officeWeekend work
$60k
...is looking for a LPN/LVN experienced in the managed care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. This individual... ...~ Career development opportunities Remote Opportunities We are actively seeking new...Remote workCmsTemporary workLocal area$82.68k - $96.46k
...Clinical Guide Part A will be part of the Utilization Management team, responsible for inpatient,... ...Schedule: This is a full-time, remote position working five 8-hour days. We are... ...skills and experience: ~ Unrestricted RN license with a minimum of 4 years of clinical...Remote workCmsFull timeContract workInternshipMonday to Friday- ...About the role We're looking for an RN who has personally owned grievance and... ...hospital-based role. The best fit has a utilization management or case management foundation and has... ...time-sensitive cases at once in a fully remote setting. Nice to haves BSN or MSN...Remote jobCms
- ...Registered Nurse Case Manager to join the team. This... ...flexible work schedules, and remote and hybrid career... ...opportunities.Registered Nurse (RN) Case Manager 1 Job... ...excess days, resource utilization, readmission rates,... ...plans of care and care paths with physicians and/or...Remote workCmsFull timePart timeReliefRelocation packageMonday to FridayFlexible hoursWeekend work
$65k - $85k
...The Licensed Vocational Nurse (LVN) - Utilization Management & Inpatient Case Management is responsible... ...to work independently in a fully remote environment. Budgeted Compensation: $6... ...additional clinical review and elevate to an RN, Medical Director, or other designated...Remote workCmsWork at office$33 - $36 per hour
...Salary Range: $33.00 To $36.00 Hourly Position Summary: The Utilization Management Nurse (UMN) works under general supervision of the Director and... ...of stay. Qualifications: Current unrestricted Florida RN or LPN License. Minimum of two years of utilization review experience...Remote workCmsHourly payWork at officeWeekend work- ...Oak Street Health is seeking a Utilization Management Physician Reviewer for a fully remote, full-time role. You will render timely coverage determinations for inpatient and outpatient services using UM criteria and clinical judgment, coordinating with care teams to ensure...Remote workCmsFull time
- ...Utilization Management NurseBHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical... ...requirements, and a member's benefit coverage while working remotely.Primary Responsibilities:Performs clinical utilization reviews...Remote workCmsContract workWork at office
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Utilization Management RN - Path to CM. Be the first to apply!
- outpatient rn Kansas City, MO
- sedation rn Kansas City, MO
- 1099 rn Kansas City, MO
- ed rn Kansas City, MO
- registered nurse office Kansas City, MO
- labor & delivery rn Kansas City, MO
- registered nurse remote Kansas City, MO
- mother baby postpartum rn registered nurse Kansas City, MO
- injection rn Kansas City, MO
- gastroenterology rn Kansas City, MO


