Remote RN Leader, Utilization Management & Appeals
Centene Corp.
Centene Corporation in Oklahoma City seeks an experienced RN to lead the Prior Authorization, Concurrent Review, Retrospective Review, and Appeals teams, ensuring compliant utilization management. This role oversees UM processes, guides standards, analyzes utilization trends, and supports senior leadership with data-driven recommendations. The ideal candidate is an Oklahoma-resident, holds an active RN license, and is prepared for weekend on-call coverage with strong leadership, communication,
#J-18808-Ljbffr- ...Corporation is seeking a senior leader to manage Prior Authorization, Concurrent Review, and Appeals teams, ensuring... ...requires an active RN license and a willingness... .... The position is remote, but candidates must reside... ...improvements in utilization management #J-18808-...Remote workWeekend work
- ...Centene Corp. is seeking a Manager of Utilization Management to oversee Prior Authorization, Concurrent Review, Retrospective Review, and Appeals teams. This remote role requires a clinical leader with strong UM experience and Oklahoma residency. You will develop, implement...Remote work
- Optum is seeking a Per Diem Utilization Management Nurse to review medical records and craft defensible appeal letters. You will extract pertinent case details, adhere to HIPAA, and follow OPAS/Optum guidelines while meeting time expectations. The role offers telecommuting...Remote jobDaily paidLocal area
$81.95k - $110.24k
...enabled revenue cycle management solutions for health... ...healthcare. The Lead Utilization Review RN is a key contributor... ...: Coordinates the appeal process with the... ...required #LI-LS1 #LI-REMOTE Join an award-winning... ...Cycle 2019-2024 Leader in Everest Group's RCM...Remote workFull timeWork at officeLocal area- ...seeking an experienced nurse leader in Oklahoma for a remote role overseeing Prior... ..., Retrospective Review, and Appeals. The position requires an active RN license and supervisory experience... ...ideal candidate will guide utilization management, coordinate with providers,...Remote workWork at office
- ...Centene Management Company LLC is seeking a Nurse leader to manage Prior Authorization, Concurrent Review, and related utilization management activities. This remote US-based role requires Oklahoma residency and an active RN license, with weekend on-call coverage. Strong...Remote workWeekend work
- Ensemble Health Partners is seeking a Lead Utilization Review RN to drive medical necessity reviews, discharge planning, and appeals coordination while collaborating with physicians... ...integrity and patient care quality in a remote US-based environment. You will evaluate...Remote job
- ...behalf of a partner company, is seeking a Case Manager - Utilization Review Specialist based in the United States. This remote role oversees admission and concurrent... ...assesses medical necessity, and coordinates appeals with physicians, payers, and case managers to...Remote job
$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 hiring a contract RN for a New York... ...medical necessity judgment you built in utilization management. 100% remote (U.S.) | Contract | $52$56/hr based on experience...Remote jobContract workAfternoon shift$39.4 - $53 per hour
...enabled revenue cycle management solutions for health... ...Position Overview The Lead Utilization Review RN is a key contributor... ...: Coordinates the appeal process with the... ...Revenue Cycle 2019‑2024 Leader in Everest Group's RCM... ...Top Workplace for Remote Work 2024 Great Place...Remote workWork at officeLocal area$100k - $130k
...those who need it most. The Utilization Management (UM) team plays a vital role... ...guidelines. As the Lead RN, Utilization Management, you... ...experience. Collaborate with Appeals and Grievances, Care Management... ...Additionally, we embrace a remote-first culture that supports...Remote workWork experience placementWork at officeFlexible hours- ...Partners is seeking an LPN/LVN experienced in the managed care UM environment to perform pre-service and post-service utilization reviews for DMEPOS, in collaboration with our... ...benefit and medical necessity reviews and appeals within a NCQA-compliant UM program, ensuring...Remote job
- ...insurance client. You will evaluate complex member cases, focusing on appeals and reconsiderations, with a path toward payer-side leadership. This remote/hybrid role requires SC residency and an active SC RN license. Onsite training is provided, with standard hours and...Remote jobWeekend work
- ...Centene Corporation seeks a Nurse Leader to manage Prior Authorization, Concurrent Review, and related UM activities. The role requires Oklahoma residency with an active RN license and offers remote work with weekend on-call coverage. Ideal candidates will have healthcare...Remote workWork at officeWeekend work
- ...is seeking a contract-based professional to manage complex grievances and appeals for members and providers in a remote US-based role. The candidate will review medical... ...requires a USRN license, at least 2 years in utilization management, strong communication, and the...Remote jobContract work
- Ensemble Health Partners is seeking a Lead Utilization Review RN to enhance financial, quality, and clinical performance across the patient care continuum. You will lead medical necessity determinations, coordinate discharge planning, and work with physicians, nurses, and...Remote job
- Ensemble Health Partners is seeking an RN, Senior Utilization Review Quality to lead quality reviews for the VUR team. You will partner with leadership... ..., and help implement training and onboarding support. This remote role may require occasional onsite travel to client...Remote job
$119.14k - $184.95k
...Care Manager Appeals RN - REMOTE position. This position is Per Diem and will work 8- hour, Day shifts. The Care Management Recovery Advocate (CMRA) is responsible for providing overall management and communication of clinically-based appeals between Providence Health...Remote workDaily paidMinimum wageShift workDay shift- ...Care Manager Appeals RN - Remote Position This position is Per Diem and will work 8-hour, Day shifts. The Care Management Recovery Advocate (CMRA) is responsible for providing overall management and communication of clinically-based appeals between Providence Health...Remote workDaily paidDay shift
- ...the role We're looking for an RN who has personally owned grievance and appeals cases from intake to final decision... ...role. The best fit has a utilization management or case management foundation... ...sensitive cases at once in a fully remote setting. Nice to haves...Remote job
- ...Job Title: Utilization Management Registered Nurse (UM RN) – SNF / MLTC Location: Remote (Must reside in NY, NJ, or CT) Schedule: Monday – Friday, 9:00 AM – 5:00 PM... ...continued stay determinations. Quality & Appeals: Identify potential overutilization, underutilization...Remote workFull timeMonday to Friday
$70.2k - $120.4k
...and every member feels valued.The Utilization Review RN will review and document member case... ...medical policies and utilization management and/or clinical appeals policies.Utilization review... ...license requiredThis position is a Remote role. To be eligible for consideration...Remote workWork experience placement$38.91 - $60.31 per hour
...Colorado For This Fully Remote Position Location:... .... Provides case management and/or consultation for... ...and concurrent denials appeals. Collaborates closely... ...as a Registered Nurse (RN). Minimum Experience:... ...Preferred: 3 years of utilization or case management experience...Remote workFull timeTemporary workLocal areaFlexible hoursShift work- ...Behavioral Health Utilization ManagerBehavioral Health Utilization Manager will perform concurrent and discharge reviews on... ...platform, adhering to BH UM and Appeals policies and procedures. Meets required... ...telephone systems Work Schedule: Remote Other Requirements: Able to work...Remote workContract workWork experience placement
$42 per hour
...Ascension Texas Utilization Management Department (Fully Remote) Provides health care services regarding admissions, case management, discharge planning... ...documentation, precertification, reimbursement and claim denials/appeals. Assesses and coordinates discharge planning needs...Remote job$38 - $40 per hour
...Title: RN -- Review Analyst Location: Remote Duration: 12 months with possible extension... ..., and retrospective utilization reviews for inpatient,... .... - Review and process appeals submitted by providers,... ...background includes Utilization Management (UM) , Case Management...Remote workHourly payWork at officeMonday to FridayShift work- Centene Corporation is seeking a fully remote RN appeals reviewer to support processing of medical necessity reviews for appeals. You... ...preferred), a BSN or CCM, and 2+ years in acute care, utilization management, or appeals. Familiarity with MCG/InterQual criteria and...Remote job
$52 - $56 per hour
Now hiring: Remote UM / Grievance & Appeals RN (NY License) | Contract | $52-56/hr Are you an RN who has owned appeals cases from intake to... ...plan, needs a clinical Grievance & Appeals nurse with a utilization management or case management background. You’ll review medical...Remote jobContract workImmediate start- Centene Management Company is seeking a licensed RN to perform clinical reviews for appeals, examining medical records and data to determine... ...standards. This is a fully remote role, with a preference for... ...2+ years in acute care or utilization management or appeals, and...Remote job
- ...Job Summary: As an on-site Hospital Utilization Management (UM) Nurse, you are the primary link between... ...and 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
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