Remote RN Leader, Utilization Management & Appeals
Centene Corporation
Centene Corporation in Oklahoma City seeks an experienced RN to lead the Prior Authorization, Concurrent Review, Retrospective Review, and Appeals teams, ensuring compliant utilization management. This role oversees UM processes, guides standards, analyzes utilization trends, and supports senior leadership with data-driven recommendations.
The ideal candidate is an Oklahoma-resident, holds an active RN license, and is prepared for weekend on-call coverage with strong leadership, communication,
#J-18808-Ljbffr- ...Corporation is seeking a senior leader to manage Prior Authorization, Concurrent Review, and Appeals teams, ensuring... ...requires an active RN license and a willingness... .... The position is remote, but candidates must... ...process improvements in utilization management #J-18808-...Remote workWeekend work
- ...Centene Corp. is seeking a Manager of Utilization Management to oversee Prior Authorization, Concurrent Review, Retrospective Review, and Appeals teams. This remote role requires a clinical leader with strong UM experience and Oklahoma residency. You will develop,...Remote work
- ...Cambia Health is seeking a Manager of Utilization Management to lead clinicians and staff across multiple... ...role combines on-site leadership with remote collaboration to optimize prospective,... ...with executives to align goals. A RN with clinical leadership and insurance...Remote workRelocation
$52 - $56 per hour
...You've done UM. You've worked appeals. Now find a role that uses both. We're hiring a contract RN for a New York health plan (Medicare Advantage,... ...medical necessity judgment you built in utilization management. 100% remote (U.S.) | Contract | $52–$56/hr based on...Remote workContract workAfternoon shift- ...Ensemble Health Partners is seeking a Lead Utilization Review RN to drive medical necessity reviews, discharge planning, and appeals coordination while collaborating with physicians... ...integrity and patient care quality in a remote US-based environment. You will evaluate...Remote work
$81.95k - $110.24k
...enabled revenue cycle management solutions for health... ...healthcare. The Lead Utilization Review RN is a key contributor... ...: Coordinates the appeal process with the... ...required #LI-LS1 #LI-REMOTE Join an award-winning... ...Cycle 2019-2024 Leader in Everest Group's RCM...Remote workFull timeWork at officeLocal area$39.4 - $53 per hour
...enabled revenue cycle management solutions for health... ...Position Overview The Lead Utilization Review RN is a key contributor... ...: Coordinates the appeal process with the... ...Revenue Cycle 2019‑2024 Leader in Everest Group's RCM... ...Top Workplace for Remote Work 2024 Great Place...Remote workWork at officeLocal area- ...We're looking for an RN who has personally owned grievance and appeals cases from intake to final decision letter... ...role. The best fit has a utilization management or case management foundation and... ...sensitive cases at once in a fully remote setting. Nice to haves...Remote work
- ...is seeking a contract-based professional to manage complex grievances and appeals for members and providers in a remote US-based role. The candidate will review medical... ...requires a USRN license, at least 2 years in utilization management, strong communication, and the...Remote workContract work
- ...Centene seeks a Grievance & Appeals Coordinator for a remote role aligned to PST. The position handles processing of member grievances and appeals and... ...experience in cross-functional teams is preferred; Oregon RN licensure is strongly preferred. #J-18808-Ljbffr...Remote work
- ...Quorum Health Corporation is seeking an experienced Utilization Review Specialist (Case Manager) to join our remote team. The role focuses on admission and concurrent... ...root-cause analysis. You must have a current RN license and extensive experience in case management...Remote work
- ...Trillium Health Resources is seeking a Nurse Manager, Utilization Management – Physical Health to lead day-to... ...service area. The role requires an RN with NC licensure and willingness to travel within the catchment; remote work options are available for many positions...Remote work
- ...Centene is seeking an experienced Supervisor of Utilization Management to lead the Prior Authorization, Concurrent Review, and Retrospective Review teams. This remote role supports members across the health plan with a focus on quality and compliance. You will supervise...Remote work
- ...Integra Partners is seeking a Licensed Practical Nurse to perform pre-service and post-service utilization management reviews and appeals within a NCQA-compliant UM program. You will collaborate with the Medical Director to assess medical necessity, benefits, and policy...Remote work
- ...Clover Health is seeking a Lead RN, Utilization Management, to coach UM nurses, oversee daily review operations, and monitor quality. You will partner... ...leadership, clinical judgment, and member-first decision-making within a remote-friendly environment. #J-18808-Ljbffr...Remote work
- ...hospitalized patients, conduct peer-to-peer reviews with payors' medical directors, and serve as a subject matter expert on utilization management (UM) issues. The role reviews short inpatient stays and observation patients daily while building strong relationships with...Remote job
- ...Ensemble Health Partners is seeking a Lead Utilization Review RN to enhance financial, quality, and clinical performance across the patient care continuum. You will lead medical necessity determinations, coordinate discharge planning, and work with physicians, nurses,...Remote work
- ...Sentara Health Plans seeks a Clinical Claims Reviewer RN for remote work. You will perform utilization management, review pre/post payment claims and authorizations for inpatient/outpatient cases, and address provider inquiries with appropriate referrals to Medical Directors...Remote workFull time
$119.14k - $184.95k
...Care Manager Appeals RN - REMOTE position. This position is Per Diem and will work 8- hour, Day shifts. The Care Management Recovery Advocate (CMRA) is responsible for providing overall management and communication of clinically-based appeals between Providence Health...Remote workDaily paidMinimum wageShift workDay shift- ...Care Manager Appeals RN - Remote Position This position is Per Diem and will work 8-hour, Day shifts. The Care Management Recovery Advocate (CMRA) is responsible for providing overall management and communication of clinically-based appeals between Providence Health...Remote workDaily paidDay shift
- ...Corporation seeks a Registered Nurse leader to supervise Prior... ...Review, Retrospective Review and Appeals teams, ensuring compliant, high-quality utilization management for members. This remote role requires Oklahoma residency, an active RN license, and willingness to...Remote workWeekend work
- ...company seeking a Clinical Denials Management Specialist based in the United States. The role is fully remote and focuses on reviewing, appealing, and preventing denied hospital claims... ...system, working with nursing, utilization management, revenue integrity, and patient...Remote work
- ...Working remotely on a full-time basis, the Connecticut Licensed Utilization Management RN will manage medical necessity reviews, authorization compliance, and reimbursement... ...summaries and medical necessity rationales for appeals, supporting provider preparation for...Remote workFull time
- ...Dallas seeks a Denials Management Specialist to lead denial... ...collaboration with Utilization Management and other teams... ...a hybrid schedule (remote with onsite 2x/month) in... ...The ideal candidate has RN licensure, at least 3 years... ...policy navigation and appeal strategies. #J-18808-...Remote work
$72.8k - $130k
...occasional opportunity for remote work based on business needs. As a Sr Utilization Management Nurse in the... ...to providers, facility leaders, and interdisciplinary... ...be a Registered Nurse (RN) with a current, active... ...authorization, and/or clinical appeal and guidance reviews...Remote workMinimum wageFull timeWork experience placementCasual workLive inWork at officeLocal area- ...Integra Partners is seeking an LPN/LVN with managed care experience to perform pre-service and post-service utilization reviews and appeals for DMEPOS. You will collaborate with... .... The role supports a nationwide remote workforce with competitive compensation,...Remote work
- ...Services and Supports, the full-time Massachusetts Licensed Utilization Management RN will manage clinical determinations, authorization support, and appeals in a hybrid role that is approximately 75% remote and 25% onsite for meetings and training. Key responsibilities...Remote workFull time
$53 per hour
...Phaxis - Healthcare is hiring for a REMOTE RN opportunity focused on Grievance & Appeals and Utilization Review. The role requires candidates to reside in New York... ...direct outpatient UM experience, strong utilization management background, and experience with prior...Remote workLong term contractContract workMonday to Friday- ...Job Title: Utilization Management Registered Nurse (UM RN) – SNF / MLTC Location: Remote (Must reside in NY, NJ, or CT) Schedule: Monday – Friday, 9:00 AM – 5:00 PM... ...continued stay determinations. Quality & Appeals: Identify potential overutilization, underutilization...Remote workFull timeMonday to Friday
- ...Engineering Technology Lead - Plant Utilities to own design, maintenance,... .... This senior, full-time, remote role requires deep expertise... ...compliance. The leader will develop capital projects... ...strong business cases for senior management, mentor local teams, and ensure...Remote workFull timeLocal area
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