Remote RN: Utilization Management & Review
Mass General Brigham Health Plan Holding Company, Inc.
- Remote job
Mass General Brigham Health Plan Holding Company, Inc. is seeking an experienced nurse for utilization review in a remote-friendly setting with occasional onsite work in Somerville, MA. The role emphasizes clinical knowledge, medical necessity determinations, and collaboration with diverse health plan teams to optimize patient care. The ideal candidate has 2–3 years of utilization review experience, familiarity with InterQual/Milliman, and strong communication skills. #J-18808-Ljbffr Mass General Brigham Health Plan Holding Company, Inc.
- ...States is seeking an Inpatient Utilization Management Clinician to evaluate inpatient... ...planning across care teams. This fully remote, full-time role requires an active RN license, nursing degree, and... ...management to ensure timely reviews, document outcomes, and maintain...Remote workFull time
- ...Job Description: Ascension Texas Utilization Management Department (Fully Remote)Job Summary:• Provides health care services regarding admissions, case management, discharge planning and utilization review.Responsibilities:• Reviews admissions and service requests within...Remote work
- ...Overview This remote position in Utilization Management requires a Registered Nurse with 2 years of experience. Responsibilities include working with providers, managing reviews, and utilizing EMR systems. The role follows a Monday through Friday schedule with...Remote workWeekly payMonday to FridayWeekend work
- ...Job Description Job Description The utilization review and management (UM) component program ensures that external healthcare services provided... ...5 pm with one hour for lunch This is an in-office, no remote work capability position Travel ~ Some travel may be...Remote workWork at office
- Centene Management Company LLC is seeking a licensed nurse... ...to perform concurrent reviews for Ambetter members in Georgia. This fully remote role follows a Monday-Friday... ...The position requires RN/LPN licensure with... ...experience; knowledge of utilization management is preferred...Remote jobMonday to Friday
$2,147 per week
...Travel RN - Case Management/Utilization Review American Traveler Somerville, Massachusetts, United States Position ID: P-762577 Position status... ...pay) Description American Traveler is hiring a remote RN for Utilization Management requiring an active MA RN...Remote workWeekly payLocal areaMonday to FridayShift work- Evry Health is seeking an RN Integrated Care Coordinator (UM) to provide... ...to ensure high-quality care in a remote environment, with rotating weekend utilization review coverage. The candidate should have 1-2 years in utilization management, 3-5 years clinical experience,...Remote job
- OU Health is seeking a Case Manager, RN for Utilization Review on a PRN basis. The role focuses on evaluating medical necessity, coordinating with payors... ...care while maintaining HIPAA compliance, even in a remote setup. The candidate will work with the Utilization Review...Remote jobRelief
- Position Title: Case Manager, RN - Utilization Review - PRN Department: OUMC Utilization Review Job Description: Remote Eligibility: Candidates must reside and work full-time in AR, KS, MO, OK, or TX before their first day of employment. Please do not apply if you reside...Remote workFull timeReliefLocal areaWork from homeRelocationShift work
$63.1k - $94.65k
...technology-enabled revenue cycle management solutions for health systems... .... Must have current compact RN license, or be willing to... .... Schedule Information: Our Utilization Review team provides coverage seven... ...Required: This is a remote role which requires access to...Remote workTemporary workWork at officeLocal areaFlexible hoursShift 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
- ...Providing timely and evidence-based utilization review services, the full-time Utilization Review RN will work remotely to manage complex medical conditions, treatment planning, and recovery for injured employees while advocating for effective medical treatment. Key responsibilities...Remote workFull timeWork experience placement
- ...TriWest Healthcare Alliance seeks a Utilization Management Clinical Review nurse to evaluate and authorize beneficiary care, focusing on cost-effective, appropriate utilization of Behavioral Health and Medical/Surgical services. Responsibilities include preauthorization...Remote work
- ...Refer a Friend Back Remote Work from Home Share This... ...Health Plans (JHHP) is the managed care and health services business... ...8:00 AM - 5:00 PM As a Utilization Review Registered Nurse for Johns... ...Unencumbered Registered Nurse (RN) license in Maryland (or...Remote workFull timeLocal areaWork from homeMonday to FridayDay shift
- ...Centene Management Company LLC is seeking a qualified nurse reviewer to conduct concurrent inpatient and pediatric/adult case reviews to validate medical necessity... ...Responsibilities include educating providers on utilization processes, sharing feedback with leadership for...Remote work
$1,600 - $1,800 per week
...Hiring: Registered Nurse – Utilization Management Location: Buckley AFB & Peterson... ...no holidays, no telehealth/remote work Minimum... ...full, active, and unrestricted RN license Certifications:... ...Utilization Management, Utilization Review, or Case Management...Remote workContract workImmediate startMonday to Friday- ...Currently seeking a Utilization Management RN . Please see details and qualifications below: Position is remote - candidate must reside in the tri-state area (PA, DE, NJ)... ...clinical conditions through medical record review to determine medical necessity for services...Remote workImmediate startDay shift
$77.08k - $119.47k
...Department/Unit: Care Management/Social Work Work Shift: Day... ...19,466.00 Responsible for Utilization Management, Quality Screening... ...skills applicable to utilization review process. 8. Excellent... ...work cannot be done from a remote location. Other Requirements...Remote workShift work$59.5k - $116.6k
UnitedHealth Group is seeking a Utilization Management Nurse RN to work remotely from anywhere in the U.S. This role involves ensuring efficient health services and requires an active RN license and 3+ years of Managed Care or Clinical experience. The successful candidate...Remote jobWeekend work- Centene Management Company LLC is seeking a remote nurse reviewer to assess concurrent care and determine appropriate levels... ...judgment and knowledge of utilization management processes. Candidates... ...of acute care experience, with RN licensure preferred and potential...Remote job
- A global talent management firm is seeking a Utilization Review Nurse for a contract role based in Pennington, NJ. The role involves performing utilization... ...coordinating discharge planning. Candidates must have an active RN license in New Jersey, strong analytical skills, and...Remote jobContract work
- ...A peer review organization is seeking a full-time remote Utilization Management Physician Reviewer. Ideal candidates must hold an MD, DO, or DPM degree with active board certification and unrestricted medical license in relevant states. The role involves performing detailed...Remote workFull timeWork from home
- ...Description Job Description: Manager of Clinical Utilization Management - Denial... ...Position Type: Hybrid (85% remote, 15% onsite in Northridge,... ...managing daily tasks, performance reviews, and any necessary... ...Registered Nursing Program; RN preferred. 2. Minimum of...Remote workPermanent employmentFull timeTemporary workFlexible hours
$45 - $50 per hour
Join Our Team as a Utilization Management RN - Make an Impact in Healthcare Are you a dedicated Registered Nurse... ...health outcomes. Whether working remotely or in a flexible hybrid setting, you'll play a key role in reviewing authorization requests, evaluating medical...Remote workHourly payWork at officeFlexible hours- ...Job TitleRegistered Nurse (RN) for Critical Incident Management TeamLocationHarrisburg, Pennsylvania... ..., you will be responsible for reviewing and evaluating critical... ...structured environment while utilizing technology to support remote and hybrid work functions. Your...Remote workWork from home
- ...Collaborating with the Medical Director, the full-time Registered Nurse Utilization Review will manage care variance reduction, ensure timely discharges, and refer members to appropriate resources while working remotely. Key responsibilities Assist in building and implementing...Remote workFull time
- ...Pre-Authorization Nurse to review prior authorization requests... ...decision-making abilities. Remote position from LA with a... ...Thurs), 8-hour shifts. Active RN license in Louisiana and 2+... ...are required; health plan or utilization management background is a plus. #J-1...Remote workShift work
$70k - $75k
...Utilization Management Registered Nurse (RN) - Remote The Utilization Management Registered Nurse is responsible for performing utilization review activities in compliance with federal and state regulations, URAC standards, and Guidehealth policies. This role applies...Remote workBi-weekly payFull timeTemporary workFor contractorsLocal areaWork from home- ...WNS, part of Capgemini, seeks a remote Utilization Review Nurse to perform medical necessity reviews and collaborate with providers to ensure compliant... ...team-oriented environment. Requirements include active RN or LVN licensure, a minimum of two years in utilization...Remote workWork at office
$30 - $38 per hour
...A healthcare organization is seeking a part-time Utilization Review Nurse RN to conduct assessments and reviews for medical necessity of treatment requests. This role involves working 28 hours per week with responsibilities such as providing reviews for pre-certification...Remote workHourly payPart time
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