Remote Clinical Utilization Review Nurse (RN/LPN)
The Elevance Health Companies, Inc.
The Elevance Health Companies, Inc. is seeking a Medical Management Clinician to review clinical information and assess medical necessity under guidelines. This role focuses on moderately complex cases and may collaborate with healthcare providers and senior staff. The position is based in Tampa, FL or Miami, FL and can be worked virtually full-time with required in-person training sessions. Shift is 8:00am–5:00pm ET, Monday–Friday, with additional hours as needed. #J-18808-Ljbffr
- ...TurningPoint Healthcare Solutions is hiring a Utilization Review Nurse to work remotely. The ideal candidate must hold a valid LPN or RN license and possess strong critical thinking and clinical expertise. Responsibilities include performing initial clinical reviews,...Remote work
- ...Comagine Health is seeking a Clinical Utilization Review Nurse (RN) to work remotely. This role involves assessing the necessity and quality of healthcare services through various review methods, ensuring compliance with clinical criteria. The ideal candidate must hold...Remote work
- ...Comagine Health is looking for a Clinical Utilization Review Nurse (RN) to perform remote assessments on the medical necessity of healthcare services. This full‑time position involves managing utilization reviews and ensuring compliance with clinical policies for quality...Remote workFull time
- A growing healthcare company in New York seeks a Utilization Review Nurse to conduct clinical reviews and ensure medical necessity authorizations are met. The ideal candidate will be an LPN or RN with critical thinking skills and attention to detail, able to manage tasks...Suggested
- ...located in Atlanta, GA, is seeking a Clinical Quality Assurance Coordinator for a fully remote position. In this role, you will ensure top-quality peer review case reports while adhering to... ...ideal candidate will be an active RN or LPN with strong clinical skills and a...Remote workWork from home
- ...Maximus is hiring a Clinical Reviewer, RN/LPN to support the PASRR program in Tennessee. You will review clinical documentation and determine the... ...level of care and prior authorization needs. This remote position requires candidates to reside in Tennessee and offers...Remote work
- ...Maximus is seeking a Clinical Reviewer, RN/LPN to support the Tennessee Katie Beckett Program. You will review clinical documentation, medical... ...children with disabilities or complex medical needs. This is a remote role requiring Tennessee residence. You will evaluate...Remote workContract work
- ...Solutions is seeking a self-driven RN or LPN to join as Clinical Quality Assurance Coordinator. This 100% remote role focuses on quality assurance of peer review reports, ensuring evidence-based... ...confidentiality. Requires active nursing license and 2+ years clinical...Remote work
$70k - $80k
Piper Companies is seeking a Remote Clinical Appeals Analyst to provide clinical expertise in reviewing and resolving complex member and provider appeals. Candidates must... ...hold an active North Carolina licensure as an RN, LPN, PT, or OT and have significant clinical...Remote jobFull timeContract workMonday to Friday$30.5 - $41 per hour
...Cardiovascular Medicine, PLLC is seeking a Registered Nurse (RN) or Licensed Practical Nurse (LPN) to join our Device Clinic team. If you have strong clinical and technical... ...assessments. Processing and scheduling remote device checks. Handle telephone triage of incoming...Remote workWork at officeLocal areaMonday to FridayWeekend work- ...We are seeking a Clinical Coordinator to assist with... ...visits, appropriate utilization and logging of chronic... ...well as working from remote depending on training... ...Of Responsibility Review and organize patient... ...Assistant (CMA) or licensed nurse (i.e. LPN or RN). Must be licensed in...Remote workFull timeMonday to FridayFlexible hours
- ...MES Solutions is seeking a Clinical Quality Assurance Coordinator (RN or LPN) for a 100% remote role. You will oversee peer review reports, ensure evidence-based rationales, and maintain alignment with client agreements and regulatory standards. The job emphasizes quality...Remote workMonday to Friday
- ...Join MES Solutions as a Clinical Quality Assurance Coordinator in a fully remote role. You will utilize your clinical skills to ensure the quality of peer review reports aligns with client instructions... .... The role requires an active RN/LPN license and a commitment to delivering...Remote work
- ...Requirements Maximus is hiring a Clinical Reviewer RN/LPN to support our LTSS Tennessee... ...of care decision. **This is a remote position; candidates must reside in Tennessee... ...process designed to d etermine whether a nursing facility is the appropriate level of...Remote workMinimum wageContract workTemporary workWork experience placementWork at officeHome office
- Maximus is hiring a Clinical Reviewer, RN/LPN to support Tennessee Katie Beckett Program. You will review medical records, assessments, and supporting... ...with disabilities or complex medical needs. This is a remote position requiring residence in Tennessee. You will ensure...Remote job
- MES Solutions is seeking a Clinical Quality Assurance Coordinator to ensure exceptional quality in peer review case reports. This remote role involves working Monday to Friday, performing... .... Candidates must hold an active RN/LPN nursing license and have at least two years...Remote jobMonday to Friday
$26.5 - $28.5 per hour
...Join Our Team as a Clinical Quality Assurance Coordinator! Are... ...you’ll ensure that our peer review reports meet the highest standards... ...: ~5+ years of RN or LPN experience ~ A keen eye for... ...Workplace Type This is a fully remote position. Application Deadline...Remote workContract workTemporary workFlexible hoursShift workDay shift$26 - $28 per hour
...Clinical Reviewer, RN/LPN (Remote - TN) Essential Duties and Responsibilities: Review requests for services including admission, discharges and continued stays for adherence to clinical criteria, state and federal policy, and related requirements. Issue approvals...Remote jobMinimum wageContract workTemporary workWork experience placement- ...operations team, the Primary Care Nurse works directly with Mercy... ...providers, and other members of the clinical care team to drive quality... ...Details: ~ Full Time RN/LPN Position @ Mercy Family Medicine... ...Springfield ~ Hours: 8a-5p ~ Hybrid/Remote Position ~90 days of onsite...Remote workFull time
- ...Behavioral Health Clinical Specialist (LPN or RN) Fast Pace Health strives to provide... .... This is a fully remote role with flexible schedule... ...appropriately to agitated patients Review schedules to ensure... ...Degree as a Licensed Practical Nurse (LPN) or Registered Nurse (...Remote jobSeasonal workLocal areaMonday to FridayFlexible hours
- ...Director of Physicians Clinic & Vice President of Patient... ...Hours: 36-40 hours Remote Position: No Pay:... ...and paid time off. To review your benefit eligibility... ...& Experienced RN/LPN/MAs welcome to apply!... ...provides professional nursing care for clinic patients...Remote workFull timePart timeLocal areaShift work
$81.1k - $116.48k
...authorization of or delivery of clinical and non-clinical... ...This position is 100% Remote. We are hiring for the... ...for Medical Director Review ensuring that all... ...Minimum Qualifications: RN, LPN OR Dental Hygienist... ...grievances, claims processing, utilization review or utilization...Remote jobContract workTemporary workWork experience placementLocal areaMonday to FridayShift work- ...during active referral hours, with remote evening and weekend referral... ...responsive, and relationship-driven Clinical Liaison RN/LPN to lead our referral review and admissions process. This... ...position with no routine floor-nursing assignments . The primary focus...Remote workFull timeTemporary workWork at officeImmediate startRelocation packageMonday to FridayWeekend workAfternoon shiftWeekday work
- ...Should have a high level of clinical knowledge and a current... ...licensure as a RN. Preferably experienced... ...with the Medical Staff, review organizations, administration... ...able to apply current nursing knowledge to determine... ...to assure effective utilization of hospital facilities...Work at office
- ...composed of Physicians, Physician Assistants, and Nurse Practitioners, works together to deliver affordable... ...and motivated Registered Nurse to join our remote team. Job Summary: As an RN - LPN Clinical Care Coordinator , you will provide patient care...Remote workFull time
- ...team, the Primary Care Patient Care RN works directly with Mercy Primary Care... ...providers, and other members of the clinical care team to drive quality outcomes... ...accredited registered professional nursing program Licensure: RN or LPN license within the hiring state and/...Full timeShift work
$35 - $45 per hour
...Position: RN / Utilization Review Nurse Location: Sacramento, CA (ON-SITE) Employment Type: Potential contract... ...records, treatment requests, and clinical documentation to support timely,... ...Comfortable working independently in a remote or office-based setting. Working Conditions...Remote workWeekly payContract workWork at officeMonday to Friday$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... ...must have a current RN license and at least 1 year of clinical experience. Competitive hourly compensation worth $30-$38...Remote workHourly payPart time$32 - $48 per hour
...RN-Utilization Review/Case Manage Nurse - RFT Hot Job Gibson City, IL 60936 Overview Salary Range... ...Hybrid (combination of in person and remote considered) GENERAL SUMMARY... ...issues on a case-by-case basis with clinical staff. Demonstrates working knowledge...Remote workHourly payFull timeWork at officeRelocation packageShift work- ...POSITION SUMMARY: The Utilization Review Registered Nurse (UR RN) is a key contributor to the delivery of appropriate... ...conducts comprehensive reviews of clinical documentation, assesses medical... ...as required for facility based staff; optional for remote staff.Remote workWork at office
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