Remote RN Utilization Review Specialist
Sedgwick Claims Management Services
Sedgwick is seeking a Telecommuter RN for Utilization Review in the United States. The role requires an active RN license, an associate degree (bachelor’s preferred), and 4 years of related experience with utilization review. Certification is a plus.
The position offers remote work with a comprehensive benefits package and competitive pay. Primary duties include reviewing treatment plans, obtaining medical records, and applying criteria to support cost-effective outcomes.
#J-18808-Ljbffr- ...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
$69.39k - $88.61k
...Cincinnati Children’s is seeking an experienced Utilization Review professional for a remote role in the United States. The position supports case management... ...a Bachelor’s degree in a related field, an active RN/Social Work/Clinical Counselor license, and 2+ years of...Remote workFull time- ...Cincinnati Children e s Hospital Medical Center is seeking a Remote Utilization Review professional to perform admission and continued stay reviews using InterQual, ensuring medical necessity and appropriate level of care. The role collaborates with Admitting, Financial...Remote work
- ...Saint Joseph Health System is seeking an RN Utilization Review specialist for a part-time, remote PRN role that requires on-site training in Mishawaka, Indiana. The position emphasizes reviewing medical necessity, insurance requirements, and discharge planning in collaboration...Remote workPart timeRelief
- ...Tennova Healthcare- Turkey Creek Medical Center is seeking a PRN Remote Clinical Utilization Review Specialist to evaluate the necessity and efficiency of hospital services and to support payer requirements. You will review admissions and continued stays, collaborate with...Remote workRelief
$65k - $85k
...Concierge Home Care | Remote Opportunity | Growth Opportunities | Increased Earning Potential At Concierge Home Care, we are growing and looking for an experienced Utilization Review Specialist (RN) to join our remote home health team. This role is ideal for an RN with...Remote workMonday to FridayWeekend workWeekday work- ...Concierge Home Care in Florida is seeking an experienced Utilization Review Specialist (RN) to join our remote home health team. The role focuses on OASIS review, coding, QA, and documentation, with certifications in Oasis and Coding encouraged. This remote position...Remote work
- HonorHealth is seeking an RN Utilization Review Specialist to review and monitor health care service utilization, ensuring appropriate levels of care and medical necessity across admissions and payer types. You will coordinate medical necessity reviews for Medicare, AHCCCS...Remote jobDaily paid
- ...Jobgether, on behalf of a partner company, seeks an experienced Case Manager – Utilization Review Specialist to oversee admission and concurrent reviews remotely in the United States. You will evaluate medical records for medical necessity, coordinate appeals, and collaborate...Remote work
$86.51k - $124.95k
...Job Overview Utilization Management Specialist RN (Remote | 0.6 FTE) Join Fairview as a Utilization Management Specialist RN and play a vital role... ..., you'll leverage your acute care and utilization review expertise to assess medical necessity, obtain authorizations...Remote workTemporary workPart timeRelocation packageFlexible hours- ...CVS Health is seeking an experienced Utilization Management Nurse Consultant (RN) for remote concurrent review in Acute Inpatient Utilization Management. You will assess medical necessity, collaborate with hospitals and care teams, and guide discharge planning to ensure...Remote work
- ...Logan Health is seeking a Utilization Management Specialist to join our dedicated team. You’ll review admissions across the Logan Health system, collaborate with physicians... ...offers a four 10-hour shift schedule, remote work with Montana residency, and a competitive...Remote workShift work
- ...Health Medical Center is seeking a Utilization Management Specialist to review admissions across the system and determine... ...status. This role suits an RN or Social Worker with acute care experience... ...insurers. The position is fully remote for Montana residents and offers a...Remote work
- ...Logan Health is hiring a Utilization Management Specialist to join the UM team. The role focuses on reviewing admissions, validating documentation and determining appropriate... ...proficiency, with a four-day work week and remote options for Montana residents. #J-18808-Ljbffr...Remote work
$60k - $66.56k
...SUMMARY: The Utilization Review Specialist will perform utilization review of pre-certification and concurrent clinical utilization reviews with insurance companies in accordance with certification requirements of each patient’s insurance plan. This position requires...Remote workFull timeFlexible hours$34.82k - $55.99k
...The Utilization Review (UR) Intake Specialist provides staff support services including typing reports and correspondence, file handling and forms completion... ...Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. #LI-Remote...Remote workHourly payMinimum wageFull timeWork at officeLocal areaFlexible hours$63.1k - $83.65k
...Position : Utilization Review Specialist Req.# : 26-144 FTE : Full-time, exempt Unit : UAW Department... ...this position. While the position is remote, the individual in this position will... ...preferred); or Registered Nurse (RN) in Michigan with at least two (2)...Remote workFull timeTemporary workMonday to Friday- ...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
- ...UnitedHealth Group in the DC area is seeking an HCBS Utilization Management Nurse to perform pre-service coverage reviews for PDN and PCS, reporting to the DC Manager of... ...care. Requires a District of Columbia RN license and 2+ years in clinical settings, managed...Remote work
- ...Recovery Unplugged is seeking an experienced Utilization Review Specialist to join our team. This remote, part-time role focuses on obtaining and maintaining insurance authorizations, communicating with managed care organizations, and collaborating with clinical teams....Remote workPart timeWeekend work
- ...Athens Administrators has an immediate need for a full-time Utilization Review Specialist to support our Athens Managed Care department and can be located remotely if technical requirements are met and the employee resides in a state Athens operates in. The schedule for...Remote workFull timeImmediate startMonday to Friday
- ...Gosnold in Wareham, MA seeks a Utilization Review Specialist for a remote, full-time role (40 hours, 8a-4p). The position focuses on pre-certification and concurrent clinical utilization reviews with insurers, ensuring patient coverage and collaboration with Patient Financial...Remote workFull time
- ...Cincinnati Children's is seeking a Utilization Review professional to perform admission and continued stay reviews... ...certification for inpatient stays. The role requires RN licensure with relevant experience and works remotely in the United States. The position includes...Remote work
- ...Hansei Solutions is seeking an Utilization Review Specialist to act as the vital link between insurance payors and treatment facilities, advocating for clients to secure maximum authorized treatment days. The role emphasizes communication, organization, data entry, multitasking...Remote work
- ...Logan Health is seeking a Utilization Management Specialist to join our team in a fully remote role focused on inpatient admissions reviews, physician documentation assessment, and authorizations across the Logan Health system. The position emphasizes collaboration with...Remote work
- ...FHE Health in the United States seeks an experienced Utilization Review Specialist to manage clinical authorization processes, ensuring timely, accurate, and compliant communications with insurance payers. You will support patient access by securing initial and continued...Remote work
- ...and substance use treatment, the full-time Behavioral Health Utilization Review Specialist will verify benefits, complete prior authorizations, and support medical necessity criteria while working remotely. Key responsibilities Verify insurance benefits, eligibility,...Remote workFull time
- ...Alliance Health is seeking an UM Clinical Specialist RN-Physical Health (Remote, NC Based) to assess medical necessity and oversee reviews across inpatient, outpatient, and... ...5 years of nursing experience and prior Utilization Management exposure. Strong communication...Remote workWork at office
- ...Optum is seeking a Behavioral Health Utilization Review Specialist to support case management and care coordination remotely. You will review cases, determine levels of care, and coordinate transitions between inpatient and outpatient settings.You will collaborate with...Remote workMonday to Friday
- ...Kent County Cmh Authority is seeking a Utilization Review Specialist to perform reviews for I/DD, mental health, and SUD services. You will assess... ...appropriate intensity settings. The role is full-time and remote with occasional local travel within the Kent County area....Remote workFull timeLocal area
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