Remote RN Quality & Utilization Consultant
CVS Health
CVS Health is seeking a registered nurse to assess, plan, implement, and coordinate care for members in a work-from-home setting. The role focuses on facilitating coverage determinations and improving care across the continuum with strong clinical judgment and collaboration with providers.
The candidate will work in a fully remote environment, supporting 40-hour work weeks, evenings and weekend needs as required by business demands with access to essential systems and HIPAA compliance.
#J-18808-LjbffrVacancy posted 3 days ago
Similar jobs that could be interesting for youBased on the Remote RN Quality & Utilization Consultant in United States vacancy
- ...benefits for members. You will interact with providers, apply guidelines, and support utilization management within a fast-paced, quality-driven environment. The role requires an active RN license, 2+ years in adult acute or critical care, and availability for weekends,...Remote workWeekend workAfternoon shift
CVS Health
Montgomery, AL1 day ago - ...CVS Health seeks an experienced RN to assess, plan, implement and coordinate patient... ...collaborate with providers and teams to optimize utilization and outcomes while maintaining HIPAA... ...weekend/holiday hours in a full-time, remote-capable position within Alabama. #J-18808...Remote workFull timeWeekend work
CVS Health
El Paso, TX1 day ago - ..., coordinate, and evaluate care options for members. You will work with providers to determine coverage determinations and promote quality care within a collaborative, HIPAA-compliant framework. Responsibilities include gathering clinical information, applying guidelines...Remote jobFull time
- CVS Health is seeking an RN for utilization management to assess, plan, and coordinate healthcare services for members. The role focuses on applying clinical judgment to determine appropriate coverage and treatment options, while collaborating with providers to optimize...SuggestedWeekend workAfternoon shift
- ...CVS Health is seeking a Registered Nurse with 5–7 years in quality or HEDIS roles to lead performance improvement initiatives. You will... ...regulatory alignment, and ongoing education for healthcare professionals. 40 hours weekly; remote work in the U.S. #J-18808-LjbffrRemote work
CVS Health
United States2 days ago - ...Humana is seeking a dedicated Utilization Management Registered Nurse to interpret and support clinical and administrative determinations for post-acute care services including SNF, Home Health, and DME. You will work from home or hybrid, reporting to the Manager of...Remote workWork from home
Humana, Inc.
United States1 day ago $26.01 - $62.32 per hour
...ourselves accountable and prioritise safety and quality in everything we do. Join us and be part of... ..., one family and one community at a time. RN Utilisation Management Nurse Consultant (Medicare – Joint Procedures) Remote | Full-Time | Monday–Friday (9:00 am to 5:30...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeMonday to FridayAfternoon shiftWeekday workCVS Health
Arkansas City, KS1 day ago- ...Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation, and communication of medical services and benefit determinations. You will work with the One Home/Home Solutions Utilization Management team handling post-...Remote workWork from home
Humana
Columbia, SC6 hours ago - ...Arkansas Blue Cross and Blue Shield is seeking an RN Utilization Management Nurse to perform clinical reviews for medical necessity across various services. The role involves weekend coverage and work from home within Arkansas and several western states. The ideal...Remote workWork from homeWeekend work
Arkansas Blue Cross
United States1 day ago - ...CVS Health Corporation is seeking an RN Concurrent Review Nurse to join a remote team delivering inpatient clinical expertise to ensure medically necessary... ...license, 5+ years inpatient nursing, and 2+ years in utilization management or discharge planning, with an Associate...Remote workWork from homeMonday to FridayWeekend work
CVS Health
Jackson, MS2 days ago - ...Health Corporation seeks an experienced Registered Nurse (RN) to support 24/7 Utilization Management operations. You will review cases, assess... ...coordinate care, and ensure members receive appropriate, high-quality healthcare services. Join a dynamic team driving...Remote workWork from home
CVS Health
United States5 days ago - ...Humana is seeking an Utilization Management Registered Nurse to interpret and support coordination, documentation, and communication of medical services and benefit determinations. The role reports to the Manager of Utilization Management as part of the One Home/Home Solutions...Remote work
Humana
United States2 days ago - ...Humana is seeking a Utilization Management Registered Nurse to support coordination, documentation, and communication of medical services and benefit determinations for post-acute care, including SNF, home health, and DME. You will report to the Manager of Utilization...Remote work
Humana
United States1 day ago - ...Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation, and communication of medical services and benefit determinations for post-acute care (SNF, Home Health, DME). The role reports to the Manager of Utilization...Remote work
Humana
United States22 hours ago - ...HealthEdge in the United States seeks a Telephonic Utilization Management RN for Behavioral Health to coordinate care and perform medical necessity... ...experience, and 1+ year in Behavioral Health/utilization management; remote work across time zones as #J-18808-LjbffrRemote work
Wellframe
United States4 days ago - ...Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation, and communication of... ...You will use clinical nursing skills to determine medical necessity and coordinate care, with potential remote #J-18808-LjbffrRemote work
Humana
United States1 day ago - ...Centene is seeking a remote Utilization Review Nurse to perform concurrent reviews, determine appropriate levels of care, and support discharge... ...and occasional weekends/holidays. The ideal candidate has RN or LPN licensure, 2+ years acute care experience, and knowledge...Remote workMonday to Friday
Centene Management Company
United States22 hours ago $76k
...a BPO Clinical Review Specialist in the United States, with remote work available for Florida residents. The role requires an active RN license (Florida or Compact) and at least 3 years of appeals, utilization management, or clinical review experience. Salary is $76,...Remote workNTT Group
United States7 hours ago- ...Health is seeking an experienced Registered Nurse for a remote Utilization Management Nurse Consultant role focused on Medicare joint procedures. You will... ...care and utilization. The position requires 3+ years RN experience, an active RN license, an associate degree in...Remote work
CVS Health
United States3 days ago - ...Humana is seeking an Utilization Management Registered Nurse to interpret and support the coordination, documentation, and communication... ...Utilization Management team. The role requires an active Compact RN license, 1 year of RN experience, and a passion for improving...Remote work
Humana
United States2 days ago - ...Amerit Consulting is seeking an experienced Utilization Management Nurse (RN) in California for a remote 6-month contract. The incumbent will support inpatient utilization review, medical necessity determinations, and facility claims compliance, auditing DRG classifications...Remote workContract work
Amerit Consulting
United States1 day ago - ...Humana is seeking a qualified Utilization Management Registered Nurse to join the One Home/Home Solutions UM team. This remote role focuses on interpreting medical criteria, coordinating documentation, and communicating determinations for post-acute care services including...Remote work
Humana
United States1 day ago - ...support patient care initiatives, the full-time Florida Licensed Utilization Management RN will monitor admissions, perform medical necessity reviews,... ...with the multidisciplinary care team in a fully remote setting. Key responsibilities Monitor admissions and perform...Remote workFull time
Virtual Vocations Inc
United States3 days ago - ...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... ...reviews, and continued stay determinations. Quality & Appeals: Identify potential...Remote workFull timeMonday to Friday
Medix™
New York, NY3 days ago - ...Humana is seeking a remote Utilization Management Behavioral Health Professional 2 in Indiana. The role requires an active RN license in Indiana, an ASN (BSN preferred), and 1+ year of clinical and managed care experience. You will coordinate with providers and members...Remote work
Humana
United States1 day ago - ...HealthEdge Software, Inc. is seeking a highly motivated Utilization Review RN to join our team. The RN will perform prospective, concurrent and retrospective reviews of inpatient, outpatient, and ancillary services to ensure medical necessity, appropriate length of...Remote workContract work
HealthEdge
United States4 days ago - ...CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant (RN), remote and full-time with a weekend schedule after training. You’ll review clinical information for coverage determinations, apply guidelines, and coordinate with care teams...Remote workFull timeWeekend workAfternoon shiftWeekday work
CVS Health
United States5 days ago - ...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
Virtual Vocations Inc
United States5 days ago - ...Utilization Management Registered Nurse at Humana uses clinical nursing skills to interpret and support coordination, documentation and communication of medical services and benefit determinations for post-acute care services including SNF, Home Health and DME. You...Remote work
Humana
Jackson, MS6 hours ago $70k - $75k
...Utilization Management Registered Nurse (RN) - Remote ~ Full-time WHO IS GUIDEHEALTH? Guidehealthis a data-powered, performance-driven healthcare... ..., Guidehealthempowers our partners to deliver high-quality healthcare focused on outcomes and value inside and...Remote workBi-weekly payFull timeTemporary workFor contractorsLocal areaWork from homeGuidehealth
United States6 hours ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote RN Quality & Utilization Consultant. Be the first to apply!
Related searches
- public health registered nurse United States
- temporary rn United States
- cath-lab rn United States
- perioperative rn United States
- part time rn United States
- pacu rn United States
- travel registered nurse l&d United States
- nicu registered nurse United States
- telephonic rn United States
- rn urgent care United States