Remote Utilization & Precertification Nurse Specialist
CVS Health
- Remote job
CVS Health is seeking a Utilization Management Nurse Consultant (Medicare) to review cases and determine appropriate coverage while working fully remote on a Monday–Friday schedule. You will apply clinical judgment to safeguard quality and coordinate care across teams. You’ll collaborate with providers, support utilization decisions, and contribute to improving member outcomes in a dynamic Medicare program. This non-bedside role offers growth in a nationwide health system. #J-18808-Ljbffr CVS Health
- CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) to support coverage determinations and care coordination. This remote, full-time role features a weekend schedule after training and requires strong clinical judgment and proficiency...Remote jobFull timeWork at officeWeekend work
- ...Medix™ seeks an experienced Utilization Review Nurse Specialist for a fully remote role in the United States. You will evaluate medical necessity, determine level-of-care decisions, and collaborate with physicians, interdisciplinary teams, and commercial carriers to optimize...Remote work
- Medix is seeking a highly skilled Utilization Review Nurse Specialist for a fully remote role in the United States. The RN will assess medical necessity and level-of-care decisions, collaborating with physicians and payers to ensure appropriate care and revenue integrity...Remote job
- UnitedHealth Group’s Optum is seeking an Utilization Management Nurse to review medical records, extract case details, and craft defensible appeal letters under policy guidance. The role supports telecommuting within the United States and follows a Monday-Friday schedule...Remote jobWork at officeMonday to Friday
- ...clinical expertise as well as knowledge of utilization and discharge planning criteria to... ...discretion. Education Required -Registered Nurse Diploma Preferred - Associate's or... ...whether the position you are interested in is remote or on-site. Individuals who reside in...Remote jobFull timeWork experience placementLocal areaImmediate startFlexible hoursWeekend work
- MaziCTools is seeking a Freelance Utilization Management Nurse Consultant to work remotely in the United States. This full-time role requires an active RN licensure and 3+ years of clinical experience. Responsibilities include assessing healthcare services, communicating...Remote jobFull timeFreelanceWork at officeMonday to FridayWeekend work
$34 - $35 per hour
...Utilization Management - Clinical Nurse - Work from Home! Utilization Management - Clinical... ...Attraction and Branding Specialist Lead @ BroadPath |... ...will be responsible for precertification of inpatient hospitalizations... ...- Prior Authorization Remote Registered Nurse (Remote...Remote workFull timeWork at officeWork from homeNight shift$54.1k - $116.76k
Behavioral Health Precertification / Utilization Management Clinician 100% Remote | Monday-Friday | 12:00 PM - 8:30 PM EST Are you a licensed Behavioral Health professional... ...another Behavioral Health discipline Registered Nurses Associate Degree in Nursing (ADN) with...Remote workHourly payFull timeTemporary workLocal areaMonday to FridayWeekday work- Gainwell Technologies is seeking a Nurse Reviewer to perform clinical reviews to determine if documentation supports the need for the service according to criteria and policies. This role emphasizes accuracy, compliance, and timely decisions within contract-specific review...Remote jobContract workWork from homeFlexible hours
$70k - $75k
...Utilization Management Registered Nurse (RN) - Remote ~ Full-time WHO IS GUIDEHEALTH? Guidehealthis a data-powered, performance-driven... ...timely reviews of healthcare services, including precertification and concurrent reviews, using approved medical necessity...Remote workBi-weekly payFull timeTemporary workFor contractorsLocal areaWork from home$29.1 - $62.32 per hour
...bigger – helping to simplify health care one person, one family and one community at a time. Utilization Management Nurse Consultant - Clinical Precertification RN (Medicare) Remote | Full-Time | Monday-Friday Are you a Registered Nurse looking to leverage your...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeMonday to FridayAfternoon shift- ...CVS Health is seeking a Utilization Management Nurse Consultant (Clinical Precertification RN) to work remotely on a full-time Weekday schedule. You will review cases, determine coverage, and collaborate with care teams to ensure appropriate treatment, while applying clinical...Remote workFull timeWeekday work
$26.01 - $62.32 per hour
...family and one community at a time. RN Utilization Management Nurse Consultant (Medicare - Joint Procedures) Remote | Full-Time | Monday-Friday (9:00 am to 5:3... ...and assess clinical information for Medicare precertification (joint procedures) Apply evidence-based...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeMonday to FridayAfternoon shiftWeekday work- ...Job Description: Ascension Texas Utilization Management Department (Fully Remote)Job Summary:• Provides health care services regarding admissions, case... ...related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.• Assesses...Remote work
$26.01 - $62.32 per hour
...– helping to simplify health care one person, one family and one community at a time. Utilization Management Nurse Consultant Clinical Precertification RN (Medicare) Remote | Full-Time | Weekday Schedule Are you a Registered Nurse ready to make an impact beyond...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeMonday to FridayAfternoon shiftWeekday work- ...CVS Health is seeking an experienced Medicare Precertification Utilization Management Nurse Consultant (RN) to support coverage determinations remotely. The role requires collaborating with providers and care teams to coordinate treatment plans and ensure appropriate member...Remote work
- ...CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) for remote, full-time weekend coverage. You will review clinical information to support coverage determinations and collaborate with providers to coordinate care. Ideal candidates...Remote workFull timeWork at officeShift work
- ...Health Corporation is seeking an experienced Oncology Nurse Consultant to lead clinical care management and utilization coordination across a patient’s cancer journey.... ...optimize outcomes while controlling costs. Fully remote nationwide role with ongoing professional...Remote job
- ...CVS Health is seeking an Utilization Management Nurse Consultant for Medicare precertification, remotely accepting applications nationwide. The role emphasizes clinical judgment and collaboration to ensure appropriate care timing and treatment, aligning with Medicare guidelines...Remote workWork at office
- ...CVS Health is seeking a Utilization Management Nurse Consultant Clinical Precertification RN (Medicare) for a remote, full-time role. You will review cases, coordinate care, and apply clinical judgment to support decisions, serving as a resource across stakeholders....Remote workFull timeWeekday work
$1,766.5 per month
...Travel Offering Nursing Profession Registered... ...Nurse Specialty Utilization Review Job ID 385... ...Department operating fully remote - Provide exceptional... ...records/documentation - Precertification - Reimbursement and claim...Remote workWeekly payWork experience placementShift work$29.1 - $62.32 per hour
...helping to simplify health care one person, one family and one community at a time. Utilization Management Nurse Consultant Clinical Precertification RN (Medicare Home Care) Remote | Full-Time | Weekday Schedule Are you a Registered Nurse ready to make an impact beyond...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeMonday to FridayAfternoon shiftWeekday work- CVS Health Corporation is seeking an experienced Registered Nurse to join our Utilization Management team in a fully remote precertification role. Preference is given to Virginia residents or candidates holding Virginia and Compact RN licenses. The position involves reviewing...Remote job
- ...Description: Nurses - are you looking for a change? Want to work... ...* Work-life balance. * Remote setting ROLE DESCRIPTION: This individual will utilize clinical knowledge and communication... ...in completion of precertification and concurrent review within...Remote workTemporary workMonday to FridayFlexible hours
$29.1 - $62.32 per hour
## Utilization Management Nurse Consultant - Behavioral Health (Remote)Apply: Remote/Hybrid: AZ - Work from home: Full time: Posted Today: End Date: October 28,... ...both inpatient and outpatient services requiring precertification.* Utilization Management nurses use specific...Remote jobHourly payFull timeTemporary workWork experience placementWork from homeMonday to FridayFlexible hoursShift workWeekend work- Epitec seeks a Registered Nurse Review Analyst to support inpatient precertification and utilization management in a fully remote environment. You will perform prospective, concurrent, and retrospective medical reviews to determine medical necessity, level of care, intensity...Remote job
$26.01 - $62.32 per hour
## A1A Precertification NurseApply: Remote: NC - Work from home: Full time: Posted Today: End Date: October... ...or High Point, NC.**Precertification Nurse Case Manager is responsible for reviewing... ...and eligibility.* Drives effective utilization management practices by ensuring...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeMonday to FridayAfternoon shift- CVS Health is seeking an experienced RN for a fully remote Precertification Nurse role within Utilization Management. Virginia residents are preferred, with a compact RN license and at least 3 years of nursing experience. You will review requests, gather documentation,...Remote job
- CVS Health is looking for a Utilization Management Nurse Consultant (Clinical Precertification RN) to evaluate cases and ensure appropriate care for Medicare members. This remote, full-time role follows a weekday schedule with a base hourly pay range. You will review cases...Remote jobHourly payFull timeWeekday work
$26.01 - $68.55 per hour
## Utilization Management Nurse ConsultantApply: Remote: IL - Work from home: Work At Home-Idaho: Work At Home-Arkansas: NC - Work from home: Work At Home... ...include holidays and evening hours.* **Medicare Precertification Utilization Management Nurse Consultant position:*...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeMonday to FridayAfternoon shift
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