Remote Utilization Management Clinician
Blue Cross Blue Shield of Arizona
- Remote job
Blue Cross Blue Shield of Arizona is seeking a qualified professional responsible for handling customer inquiries related to health insurance. The role emphasizes excellence in service, compliance, and adherence to regulations. With a focus on utilization management, candidates should have experience in clinical fields or health insurance. The position allows for remote work within Arizona, requiring effective communication and organizational skills, and involves maintaining precise records and meeting established performance goals. #J-18808-Ljbffr Blue Cross Blue Shield of Arizona
- Community Health Plan of Washington is hiring a Level I Utilization Management Clinician. You will perform utilization reviews for medical and behavioral... ...to local facilities 1-3 times weekly is expected, with a remote work option within Washington state. #J-18808-Ljbffr...Remote jobLocal area
- ProMedica is seeking a Utilization Management RN for a remote, part-time role in Ohio with a 20-hour work week. You will review admissions and transfers... ...payer rules for authorizations, and collaborate with clinicians to optimize resource use and care quality....Remote jobPart timeWork from home
- ...A healthcare provider in California is seeking a Supervisor of Utilization Management to oversee operations of the Pre-Authorization team. This role requires 5+ years of clinical experience and 3+ years in utilization management. You'll manage staffing, coordinate referrals...Remote work
$75.3k - $135.4k
...Centene Corporation is seeking a Clinical Supervisor to oversee the utilization management team ensuring appropriate care for members. The ideal candidate will supervise day-to-day activities, collaborate on complex member care issues, and maintain compliance with healthcare...Remote work- ...Full Time Days 7am-4:30pm 40 Hours/Week Utilization management and pediatric nursing experience preferred Summary: The Utilization... ...experience: 3 years is required. 4. Years of experience supervising: None. Full Time FTE: 1.000000 Status: Remote...Remote workFull time
- ...mission of Building Healthier Communities Together. This is a remote position in which we are able to employ in the following... ...candidate will have the following experience: ~ ~ Health plan utilization management ~ Medicare and Medicaid rules and regulations and health...Remote work
- ...Centene Corp. is seeking a Supervisor, Utilization Management (RN) to lead and supervise our Clinical Review team. This role focuses on ensuring appropriate care for our members and promotes adherence to compliance standards through effective team management and continuous...Remote workFlexible hours
$59.5k - $116.6k
...UnitedHealth Group is seeking a Utilization Management Nurse RN to work remotely from anywhere in the U.S. This role involves ensuring efficient health services and requires an active RN license and 3+ years of Managed Care or Clinical experience. The successful candidate...Remote workWeekend work$45k - $70k
...A healthcare services company is seeking a Utilization Management Nurse Reviewer to ensure medical services are used appropriately. The role involves reviewing medical records and coordinating care while adhering to guidelines. Candidates should possess an unrestricted...Remote work- ...Brighton Health Plan Solutions, LLC is seeking an Utilization Management Nurse to perform medical necessity reviews remotely. Licensed LPN with strong MS Office skills will review clinical criteria, coordinate with care partners, and document determinations in compliance...Remote work
$26.35 - $39.53 per hour
...NeueHealth is seeking a Concurrent Utilization Review Nurse responsible for real-time clinical reviews to ensure the medical necessity of healthcare services. The role includes conducting assessments, coordinating with providers, and collaborating with the Medical Director...Remote workHourly pay- ...Utilization Management Registered Nurse (UM RN) We're seeking a dedicated and detail-oriented Utilization Management Registered Nurse (UM RN... ...Medicare Advantage regulations (LCD/NCD policies). This is a fully remote opportunity requiring discipline, accuracy, and effective...Remote work
$71.1k - $97.8k
...A healthcare company is seeking a Utilization Management Registered Nurse to utilize clinical nursing skills for coordination and communication of medical service determinations. This remote role requires an RN license and at least one year of clinical experience, focusing...Remote work- ...Swedish Medical Group is looking for a Physician Advisor to provide leadership within Utilization Management. This fully remote role targets Washington ministries, emphasizing high-value care and effective medical necessity practices. The ideal candidate will have an...Remote work
$29.1 - $62.32 per hour
...UM Nurse Consultant Fully Remote- WFH Schedule: Monday-Friday 8a-5p EST/9a-6p CST... ...with 1 hour lunch Position Summary Utilizes clinical experience and skills in a... ...administration of the utilization/benefit management function. Required Qualifications...Remote workHourly payFull timeTemporary workWork at officeWork from homeMonday to Friday$1,600 - $1,800 per week
...NOW HIRING: Registered Nurse - Utilization Management Location: Buckley AFB & Peterson AFB, Colorado Military Health System Compensation... ..., 0730-1630 No weekends, no holidays, no telehealth/remote work Minimum Qualifications ~ U.S. Citizenship...Remote workContract workImmediate startMonday to Friday- A healthcare management organization is seeking a Utilization Management Nurse to oversee health service utilization while collaborating with external entities... ...offers a comprehensive benefits package including remote work options. #J-18808-Ljbffr Healthcare Management...Remote job
- Santa Barbara Cottage Hospital is seeking a licensed practical nurse to join BHPS Utilization Management as a remote reviewer of medical necessity and benefit determinations. You will assess cases using clinical guidelines and coordinate with providers and departments...Remote job
- Appworkshub is seeking a dedicated and detail-oriented Utilization Management Registered Nurse (UM RN) to join our remote healthcare team. In this role, you will conduct inpatient and outpatient utilization reviews, support transitions of care, and ensure compliance with...Remote job
- ...This role is part of a multidisciplinary team focused on member care within a managed care framework. The position requires R.N. licensure in NC, five years of clinical experience, including acute care and utilization management experience. #J-18808-Ljbffr Vaya HealthRemote job
- A leading medical review company in Washington is seeking a Utilization Management Nurse Reviewer. The role involves assessing medical necessity... ...experience. The position offers a competitive salary range, remote work options, and a comprehensive benefits package including...Remote work
- ...About The Role BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity... ...requirements, and a member’s benefit coverage while working remotely. Primary Responsibilities • Performs clinical utilization...Remote workContract workWork at office
- Truman Medical Centers is seeking an experienced Utilization Management RN to join the Care Continuity team in Missouri. You will partner with interdisciplinary teams to optimize resource use, monitor care delivery, and guide discharge planning. This full-time role requires...Remote jobFull time
- A healthcare recruitment firm is seeking a Lead Healthcare Recruiter (Utilization Management RN) for a remote 6-month contract. The ideal candidate will have an active RN license and experience with health plan operations. Responsibilities include evaluating healthcare...Remote jobContract work
$45k - $70k
A healthcare management firm is seeking a Utilization Management Nurse Reviewer to ensure efficient use of medical services. The role involves reviewing medical records, assessing treatment necessity, and collaborating with healthcare providers. Candidates should possess...Remote job- TEXAS INDEPENDENCE HEALTH PLAN INC is hiring a Utilization Management Nurse to work remotely in Texas. This position requires evaluating inpatient and outpatient services, ensuring compliance with CMS requirements, and collaborating with healthcare professionals. The ideal...Remote job
- A healthcare staffing agency is seeking a Utilization Management RN to work remotely from PA, DE, or NJ. The role involves assessing clinical information, determining medical necessity for services, and collaborating with providers. Candidates should have at least three...Remote jobFlexible hoursWeekend workDay shift
- Guidehealth is hiring a Utilization Management Registered Nurse (RN) for a remote, full-time position in Illinois. You will perform utilization review activities, apply medical necessity criteria, and document findings to support determinations. You will collaborate with...Remote jobFull time
$77.96k - $120.37k
Santa Barbara Cottage Hospital is seeking a Utilization Review Supervisor RN to direct operations within the department. This remote role requires a leader adept in managing a team, ensuring service quality, and handling human resources matters. The ideal candidate will...Remote job- Brighton Health Plan Solutions seeks an experienced Utilization Management Nurse (LPN) to perform medical necessity and benefit reviews remotely. You will work within UM processes, coordinate with partners, and ensure timely, compliant documentation and communications...Remote jobWork at office
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