Remote RN: Utilization Management & Care Coordination
Morgantown, PA
- Remote job
CVS Health in the United States is seeking a Registered Nurse (RN) for its Utilization Management team. You will review clinical information to support coverage determinations and care recommendations, applying guidelines, policies, and professional judgment across the continuum of care. Collaborating with providers and healthcare teams, you will facilitate quality patient outcomes, identify opportunities for care management referrals, and promote effective utilization and quality improvement #J-18808-Ljbffr Morgantown, PA
- ...experienced Registered Nurse (RN) to join our Utilization Management team. You will help... ...members receive the right care at the right time through... ...clinical review and care coordination. Active RN license and 2+... ...weekends, and holidays, in a remote-capable environment...Remote jobFlexible hoursAfternoon shift
- Highmark Health is seeking a full-time, remote Care Manager with weekend availability to support utilization management and care coordination across Saturday, Sunday and three weekdays... ..., and resolving quality issues. Required RN licensure (PA or multi-state via eNLC) and...Remote jobFull timeWeekend workWeekday work
- Highmark Health is seeking a full-time Remote Utilization Management/Case Management RN. The role reviews care appropriateness, applies criteria for resource use, refers to Health Coach/case management when needed, and analyzes data to improve provider and member satisfaction...Remote jobFull timeWeekend workWeekday work
- Highmark Health in the United States is seeking a Nurse for Utilization Management in a fully remote role requiring weekend availability (Saturday and Sunday... ...weekdays. The position focuses on review of health care services, applying criteria to ensure appropriate resource...Remote jobWeekend workWeekday work
- ...CVS Health is hiring an experienced Registered Nurse (RN) for Utilization Management to ensure appropriate care at the right time through evidence-based review and coordination. This role supports 24/7 operations and may require evenings, weekends, and holidays from a...Remote workWork from homeWeekend workAfternoon shift
- Humana is seeking a Utilization Management Registered Nurse to interpret and coordinate medical services and benefit... ...for post-acute care programs (SNF, Home Health... ...documentation while working remotely with periodic travel to... ...must have a Compact RN license, 1+ year of RN...Remote work
- ...CVS Health is seeking a Utilization Management Nurse Consultant (Remote) to support Florida Medicare home-care requests. You will review cases, determine coverage, and coordinate with providers to ensure timely... ...position requires an active RN license, 2+ years of experience...Remote workFull time
$70k - $75k
...Utilization Management Registered Nurse (RN) - Remote The Utilization Management Registered Nurse is responsible for... ...outpatient services, Quality of care concerns. Interfacing routinely... ...reliable and user-friendly. Care Coordination & Quality Support...Remote workBi-weekly payFull timeTemporary workFor contractorsLocal areaWork from home$113.73k - $170.46k
...patients receive high-quality care while efficiently utilizing medical resources. Reviews... ...~ Registered Nurse (RN) licensure in the state of... ...variances to the on-site care management teams when appropriate.... ...stakeholders to ensure a coordinated and efficient care process...Remote workFull timeWork experience placement- ...seeking a Medicare Precertification Utilization Management Nurse Consultant. You will assess and coordinate care, determine coverage and... ...The role requires 3+ years of RN experience, an active RN license, and Med/Surg exposure. Remote work from home with flexible scheduling...Remote jobWork at officeWork from homeFlexible hours
- ...experienced Registered Nurse for a remote Utilization Management Nurse Consultant role focused on... ...collaborate with providers to coordinate treatment plans, ensuring appropriate care and utilization. The position requires 3+ years RN experience, an active RN license,...Remote work
- ...recruitment firm is seeking a Lead Healthcare Recruiter (Utilization Management RN) for a remote 6-month contract. The ideal candidate will have an... ...include evaluating healthcare services and coordinating care for members. Join a dynamic team and make a meaningful...Remote workContract work
$42 - $45 per hour
...Job Description Job Description Title: Care Management Coordinator/RN Location: 100% Remote Duration: 3+ Months (Possible FT conversion) GENERAL... ...indicated. Efficiently collaborates with the hospital utilization review department, attending physicians and...Remote jobHourly payFull timeTemporary work- ...Description Job Description The utilization review and management (UM) component program... ...the appropriate level of care, while supporting... ...necessity of treatments and coordinate care effectively # Data... ...This is an in-office, no remote work capability position...Remote workWork at office
- ...is seeking a Medicare Precertification Utilization Management Nurse Consultant via remote work in the United States. The role requires RN licensure and 3+ years of nursing... ...Microsoft Office. You will assess and coordinate care, determine coverage, and collaborate with...Remote workWork at officeAfternoon shift
- ...seeking a Medicare Precertification Utilization Management Nurse Consultant to assess, coordinate, and determine appropriate... ...collaboration with providers to facilitate care and referrals, leveraging... ...The position requires an active RN license, 3+ years of nursing experience...Remote workWork at office
$81.95k - $110.24k
...enabled revenue cycle management solutions for health... ...healthcare. The Lead Utilization Review RN is a key contributor... ...-oriented, patient care delivery system, which... ...MANAGEMENT: Coordinates the appeal process with... ...required #LI-LS1 #LI-REMOTE Join an award-winning...Remote workFull timeWork at officeLocal area- ...seeking an inpatient review nurse to join our remote utilization management team. You will oversee inpatient case reviews, coordinate referrals, and collaborate with physicians,... ...services to ensure safe, cost-effective care aligned with guidelines. The role requires strong...Remote job
- ...holidays per year Home Care & Hospice Virtual Care Center Coordinator Registered Nurse (RN) Build a Career.... ...critical moments. Utilizing virtual platforms, you... ...Leadership - Accessible managers who understand the... ...patients' conditions remotely. Develop and...Remote workFull timeTemporary workLocal areaImmediate startMonday to FridayShift workWeekend work
- Centene Management Company LLC is seeking a remote Nurse Reviewer to support Marketplace/Ambetter members across multiple... ..., determining appropriate level of care, discharge planning, and... ...effective care. Ideal candidates hold RN or LPN licensure, have acute care experience...Remote job
- HealthEdge is seeking a Telephonic Utilization Management RN to coordinate, document, and communicate all aspects of the utilization/benefit management... ...clinical needs, review authorization requests, and ensure care plans align with medical necessity across inpatient and...Remote job
$62.4k - $117.62k
...is responsible for coordinating, integrating, and monitoring the utilization of physical health... ...closely with Case Management to address member... ...benefits, and efficient care delivery processes... ...and active NYS RN license required.... ...opportunity for remote work within all jobs...Remote workFull timeContract workWork at office$40 - $45 per hour
...Immediate need for a talented RN Care Management Coordinator . This is a 03 months Contract opportunity with long-term potential and is Remote , but the candidate must be in PA, DE, NJ... ...advanced medical knowledge to cases, utilizing specified resources and guidelines to...Remote workContract workLocal areaImmediate start- ...multiple states. Our continuum of care includes skilled nursing,... ..., perform audits, mentor MDS Coordinators and have TONS of autonomy? If... ...WEEK WITH ONE DAY WORKING REMOTE** How you Will make a Difference... ...and Medicare education utilizing various types of media, technology...Remote workMonday to FridayFlexible hoursNight shift
- ...Summary: As an on-site Hospital Utilization Management (UM) Nurse, you are the... ...administrative compliance. Unlike remote roles, this position relies... ...Nurse is a Registered Nurse (RN) responsible for performing... ...necessity or the current level of care.o Medical Provider Liaison:...Remote workFull timeImmediate startShift work
- Humana is seeking an Utilization Management RN - Physical Health to support coordination, documentation, and communication of medical... .... This full-time role is remote with periodic travel to Humana'... ...to apply nursing expertise to care coordination and benefit processes...Remote jobFull timeWork at office
$42 - $45 per hour
...Job Description Job Description Title: Care Management Coordinator/RN Location: 100% Remote Duration: 3+ Months (FT conversion) This is a Utilization Management RN part time position - working every other weekend (2 days a week in a 2 week cycle).*Must be...Remote jobHourly payFull timeTemporary workPart timeFlexible hoursWeekend work2 days per week- CVS Health is hiring a Registered Nurse (RN) for Utilization Management to assess and coordinate care, ensuring appropriate utilization and outcomes. You’ll work... ...care, and flexibility for a 24/7 operation. This remote, full-time position offers a comprehensive benefits...Remote jobFull time
- ...Health Partners is seeking a Lead Utilization Review RN to drive medical necessity reviews, discharge planning, and appeals coordination while collaborating with physicians... ...revenue cycle integrity and patient care quality in a remote US-based environment. You will evaluate...Remote job
- CVS Health is seeking a Utilization Management Nurse Consultant (UMNC) for a fully remote role. The incumbent will coordinate, document and communicate all aspects of the utilization... ...management program to ensure appropriate care, timing and location while adhering to...Remote job
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