Remote Utilization Management Clinician for Impactful Care
PacificSource
- Remote job
PacificSource Utilization Management Clinician is sought to support members remotely from Florida, Tuesday through Saturday. You will collaborate with physicians, nurses, social workers and other professionals to coordinate care, assess benefits, and promote cost-effective utilization. The role requires a RN or related license, 3 years nursing/behavioral health experience, and knowledge of ICD/CPT codes. You will document case notes, perform concurrent reviews, and assist with discharge planning #J-18808-Ljbffr PacificSource
- Optum, part of UnitedHealth Group, is seeking an Utilization Management Nurse to review patient records and craft defensible appeal letters per guidelines. You will extract data, reference national criteria, and ensure accuracy and compliance. The role requires RN licensure...Remote jobMonday to Friday
- Texas Health Resources is seeking an Utilization Management RN - Clinical Review to support remote admissions reviews across THR facilities. You will assess initial... ...RN with an Associate's degree and inpatient acute care experience, plus Utilization Management exposure....Remote job
- Mass General Brigham Health Plan Holding Company, Inc. is seeking an RN-based Utilization Management Nurse to support network adequacy reviews and authorization decisions for ACO, HMO, and EPO products. The role emphasizes medical necessity assessment and robust payer...Remote job
- Harris Health System, Inc. is seeking a Utilization Management Review Nurse to evaluate medical necessity, appropriateness, and efficiency of services, ensuring care aligns with evidence-based guidelines. The role involves partnering with Care Management, Physician Advisors...Remote jobFlexible hours
- ...is seeking a Lead Healthcare Recruiter (Utilization Management RN) for a remote 6-month contract. The ideal candidate will... ...healthcare services and coordinating care for members. Join a dynamic team and make a meaningful impact in patient advocacy while maintaining a...Remote workContract work
$60.53k - $129.63k
...by passionate colleagues who care deeply, innovate with... ...and one community at a time. Utilization Management Nurse Consultant Clinical Precertification... ...RN (Commercial) Remote | Full-Time | Weekday Schedule... ...Nurse ready to make an impact beyond the bedside? Join our...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeMonday to FridayAfternoon shiftWeekday work$54.1k - $116.77k
...surrounded by passionate colleagues who care deeply, innovate with purpose,... ...one community at a time. NICU Utilization Management Nurse Consultant (Remote) Are you passionate about improving... ...? Meaningful work that directly impacts neonatal and infant health...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from home- ...Utilization Management CNADubuque, Iowa, United StatesUtilization Management AssistantLocation... ...Dubuque, IA. Also accepting remote applicants.Are you passionate about patient care and thrive in a fast-paced,... ...looking to make a meaningful impact behind the scenes. If you are...Remote workWork at office
$71.1k - $97.8k
...Become a part of our caring community Are you passionate about... ...in their communities? As a Utilization Management (UM) Nurse, you will play a... ...opportunity to make a meaningful impact, navigate complex clinical... ...Indiana. Workstyle: This is a remote position supporting members...Remote workFull timeTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to Friday$71.1k - $97.8k
...Become a part of our caring community The Utilization Management Nurse 2 utilizes clinical nursing skills to support... .... Use your skills to make an impact Required Qualifications Licensed Registered... .... Travel: While this is a remote position, occasional travel to Humana...Remote workFull timeTemporary workApprenticeshipWork at officeLocal areaWork from homeHome officeMonday to FridayShift work$70k - $75k
...Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to... ...Job Description The Utilization Management Registered... ...services Quality of care concerns Interfacing... ...review of cases impacting performance metrics and...Remote workBi-weekly payFull timeTemporary workFor contractorsLocal areaWork from home$54.1k - $129.63k
...by passionate colleagues who care deeply, innovate with... ...and one community at a time. Utilization Management Nurse Consultant Clinical Precertification... ...RN (Medicare) Remote | Full-Time | Weekday Schedule... ...Registered Nurse ready to make an impact beyond the bedside? Join our...Remote workHourly payFull timeTemporary workWork at officeLocal areaMonday to FridayAfternoon shiftWeekday work$71.1k - $97.8k
Become a part of our caring community The Utilization Management Nurse 2 utilizes clinical nursing skills to support... .... Use your skills to make an impact. Required Qualifications Bachelor's... ...information. Travel While this is a remote position, occasional travel to Humana...Remote workFull timeTemporary workApprenticeshipWork at officeWork from homeHome office$39 - $40 per hour
...Recruiter at The Judge Group Utilization Management Registered Nurse (RN) Type... ...Contract W2 Location: Remote - but MUST reside in one... ...healthcare services, coordinating care, and ensuring members... ...Ready to make a meaningful impact—without sacrificing work-life...Remote workDaily paidContract workMonday to FridayShift workWeekend work$54.1k - $142.58k
...Behavioral Health Utilization Management ClinicianWe're building... ...passionate colleagues who care deeply, innovate with... ...for a rewarding remote role that combines clinical... ...making a meaningful impact on outcomes.Schedule:... ...:Behavioral Health Clinicians: Master's degree in...Remote workHourly payFull timeShift workNight shiftWeekend work$29 - $52 per hour
...Utilization Management Nurse RNOptum Insight is improving the flow of health data... ...and drive alignment between care providers and payers, and... ...enjoy the flexibility to work remotely from anywhere within the U.S... ...committed to mitigating our impact on the environment and...Remote workHourly payDaily paidMinimum wageFull timeWork experience placementLocal areaShift workWeekend workWeekday work$71.1k - $97.8k
...Become a part of our caring community The Utilization Management Registered Nurse uses clinical nursing skills... ...areas. Use your skills to make an impact Required Qualifications:... ...Experience working in a fully remote, metrics-focused role Experience...Remote workBi-weekly payFull timeTemporary workApprenticeshipWork at officeHome office$68.13k - $119.52k
...regulatory requirements and manages concurrent and pre-bill... ...the multidisciplinary care team regarding patient... ...for in-house patients, utilizing daily commercial... ...models and trends and their impact. Previous experience... ...Schedule: ~ Fully remote position, four 10-hour...Remote workFull timeWork experience placementLocal area10 hours per weekShift work$72.8k - $130k
...Sr Utilization Management NurseOptum is a global organization that delivers care, aided by technology to help millions of people live healthier... ...opportunities. Come make an impact on the communities we serve... ...occasional opportunity for remote work based on business needs....Remote workMinimum wageFull timeWork experience placementCasual workLive inWork at officeLocal area- ...Humana is seeking a Manager, Utilization Management Nursing to lead coordination and interpretation... ...services and benefit determinations in a remote, home‑based role. You will apply... ...ensure compliant and efficient patient care. Candidates must be an active RN (Virginia...Remote workWork from home
- ...Spectrum Healthcare Resources is seeking a Utilization Manager Registered Nurse (UMRN) to work entirely remotely from home. The nurse will review cases, educate patients on appropriate care, and manage health care costs for dependents of Active Duty and eligible retirees...Remote workWork from homeMonday to Friday
- ...CVS Health is seeking an experienced Utilization Management Nurse Consultant for a 100% work-from-home role in the EST time zone. The position... ...necessity, coordinating with providers, and ensuring timely care while meeting state and federal requirements. Strong documentation...Remote workWork from home
$60.2k - $107.4k
...Utilization Management & Clinical Validation Rn Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work... ...development opportunities. Come make an impact on the communities we serve as you help...Remote jobMinimum wageFull timeWork experience placementLocal area$56.2k - $100.98k
...clinical review and assesses care related to mental... ...flexibility to work remotely from their home anywhere... ...and appropriate utilization of services Provides... ...for behavioral health clinicians required. Clinical... ...you do here makes that impact real every day. You’ll...Remote workHourly payFull timePart timeWork at officeWork from homeMonday to FridayFlexible hours$60.2k - $107.4k
...Utilization Management Nurse Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with... ...career development opportunities. Come make an impact on the communities we serve as you help us...Remote jobMinimum wageFull timeWork experience placementLocal areaMonday to FridayFlexible hoursWeekend workAfternoon shift$90k - $107k
...profit, we support patient care, research, teaching,... ...-of-network providers. Utilizing clinical knowledge, the... ...experience in a managed care setting and possess... ...self-awareness; monitor impact on others; be receptive... ...after hire. This is a remote role with occasional onsite...Remote workShift work- ...CVS Health is seeking an experienced Utilization Management Nurse Consultant for a 100% work-from-home, full-time position open to MST/PST residents... ...activities, ensuring timely, safe, and appropriate care for members. In this role you will review medical necessity...Remote workFull timeWork from home
- ...Utilization Manager Registered Nurse (UMRN)Spectrum Healthcare Resources has a need for a Utilization... ...Nurse (UMRN). These will be completely remote positions, working entirely from the... ...cases, educating patients on appropriate care and managing health care costs for the...Remote workFull timeContract workWork at officeWork from homeMonday to Friday
$48.52 - $72.78 per hour
...RN Utilization Management Reviewer - Remote (OR, WA, AK) Join PeaceHealth in advancing compassionate... ..., mission-driven care from wherever you are.... ...closely with physicians, clinicians, and multidisciplinary teams... ...to Make a Meaningful Impact? Bring your clinical expertise...Remote jobFull timeLocal areaDay shift- ...Hospital is seeking a licensed practical nurse to join BHPS Utilization Management as a remote reviewer of medical necessity and benefit determinations.... ...and NCQA guidelines, and the ability to work independently in a fast-paced managed care environment. #J-18808-LjbffrRemote work
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