Remote Inpatient Utilization Review RN
Well Sense Health Plan
WellSense Health Plan in the United States is seeking an Inpatient Utilization Management Clinician to evaluate inpatient medical necessity, monitor treatment, and support discharge planning across care teams. This fully remote, full-time role requires an active RN license, nursing degree, and experience with InterQual guidelines and managed care.
You will collaborate with physicians and care management to ensure timely reviews, document outcomes, and maintain regulatory compliance.
#J-18808-Ljbffr- ...WellSense Health Plan is seeking an Inpatient Utilization Management Clinician for a fully remote role in the United States. You will... ...outcomes. Qualifications include an active RN license, nursing degree, and 2 years of utilization review experience with InterQual. #J-18808-...Remote work
- ...Registered Nurse – Utilization Review (Remote) This is a fully remote Utilization Review RN role supporting multiple service lines and levels of care, including Inpatient, Extended Hospital Outpatient, and Observation (OBS). Minimum of 3 years acute medical Care...Remote work
- UnitedHealth Group is seeking an Inpatient Care Management Nurse to ensure proper utilization of health services by... ...in Phoenix, AZ with a fully remote work style, the role... ...acute settings and an active RN license. You will perform reviews using criteria (MCG/InterQual...Remote job
- UnitedHealth Group is seeking an Inpatient Care Management Nurse to ensure appropriate utilization of health services and... ...care. This role offers remote work and requires... ...experience and an RN license. You will collaborate... ...Directors, perform reviews, and support discharge...Remote job
- ...Summary and Responsibilities As our Utilization Review RN, you will meticulously review medical... ...interactions, and obtaining inpatient authorization from insurance providers... ...of care. This position is open to remote/out of state candidates residing in only...Remote work
- ...TriWest Healthcare Alliance seeks a Utilization Management Clinical Review nurse to evaluate and authorize beneficiary care, focusing on cost-effective... .... Responsibilities include preauthorization, inpatient and continued stay reviews, and presenting complex cases...Remote work
$78k - $88k
...Summary We are seeking a skilled Utilization Review Nurse to conduct prior authorization, prospective... ...on clinical guidelines. Maintain RN license and meet continuing education requirements... ...-offer background check. 3+ years of inpatient clinical experience. 1+ year in prior...Remote workFull timeContract workWork at officeWork from homeFlexible hours- ...to the LTSS department. RN will be responsible for... ...and concurrent review. Provides monthly telephonic... ...the medical necessity of inpatient admissions, outpatient... ...of treatment setting by utilizing the applicable medical... ...Additional Info: *possible remote opportunity after...Remote workContract workMonday to FridayFlexible hours
$30 - $34 per hour
...A healthcare services company is seeking an experienced Utilization Review Nurse to work remotely. The ideal candidate must hold an active LVN license in California and have experience in outpatient utilization management. Responsibilities include approving or denying...Remote workHourly pay- ...Broward Pace Program sites. Job Title: Utilization Review RN Job Summary The Utilization RN... ...stay, and discharge reviews for inpatient, observation, post-acute (SNF, IRF, LTACH... ...Environment Work Conditions ~ Remote role with reliable high-speed internet...Remote workFull timePart timeWork at officeLocal areaWeekend workAfternoon shift
- ...TurningPoint Healthcare Solutions is hiring a Utilization Review Nurse to work remotely. The ideal candidate must hold a valid LPN or RN license and possess strong critical thinking and clinical expertise. Responsibilities include performing initial clinical reviews,...Remote work
- ...Centene Management Company LLC is hiring for a remote RN/LPN utilization reviewer. You will evaluate patient care, determine appropriate level of care, and contribute to discharge planning while coordinating with Medical Affairs. Role requires 2+ years acute care and...Remote workMonday to Friday
- CVS Health is seeking a Utilization Management Nurse Consultant (RN) for a remote role. You will perform concurrent reviews for acute inpatient admissions and support timely transitions of care. Required RN license, 5+ years acute care, 2+ years UM/Case Management experience...Remote job
$29 - $52 per hour
...UnitedHealth Group's Optum unit is seeking a Utilization Review Nurse, RN to perform inpatient utilization management with evidence-based guidelines and medical... ...to coordinate patient care. The position offers remote work options for those in Pacific or Mountain Time, with...Remote workHourly payWeekend work- ...Gainwell Technologies LLC is looking for a Utilization Review Nurse to work remotely in Maine. You will conduct reviews for medical... ...Qualified candidates should have an active Maine RN license and at least 3 years of inpatient clinical experience. Additional benefits...Remote workFlexible hours
- ...UnitedHealth Group is seeking a Utilization Review Nurse, RN to perform inpatient utilization management in California. The role involves reviewing inpatient... ...Directors for complex cases. The position may offer remote work options and requires working a Monday–Friday schedule...Remote workMonday to FridayWeekend work
- ...To support a mission-driven health organization, the full-time Utilization Review Nurse - RN will conduct medical necessity reviews, escalate non-certifications for secondary clinical review, and analyze clinical records to ensure timely and compliant care determinations...Remote workFull time
- Devoted Health is seeking a Clinical Guide Part A to support inpatient, behavioral health, and post-acute utilization review in alignment with CMS guidelines. This remote, full-time role requires a licensed RN with several years of UR experience and familiarity with...Remote jobFull time
- ...Utilization Review NurseWe are seeking a detail-oriented and experienced Utilization... ...licensed Registered Nurse (RN) with experience in... ...ResponsibilitiesPerform utilization reviews for inpatient, outpatient, observation,... ...management department. Remote, hybrid, or on-site...Remote workWork at office
$40.12 - $62.19 per hour
...Utilization Review RNSinai Hospital's Utilization Review operates as a distinct specialty service line of physician... ...relevant clinical information.This is a Full-time remote position.Responsibilities:The Utilization Review RN reviews the medical record by applying...Remote workFull time$35 - $45 per hour
...Position: RN / Utilization Review Nurse Location: Sacramento, CA (ON-SITE) Employment Type: Potential contract to hire Pay Range: $35.00 – $4... ...-paced environment. Comfortable working independently in a remote or office-based setting. Working Conditions May be exposed...Remote workWeekly payContract workWork at officeMonday to Friday- ...Currently seeking a Utilization Management RN . Please see details and qualifications... ...below: Position is remote - candidate must reside in... ...through medical record review to determine medical necessity... ...determine medical necessity for inpatient admissions, continued stays...Remote workImmediate startDay shift
- ...Utilization Review NurseThis position has a remote option for those living close and will be able to come into the hospital as needed.The Utilization Review... .../Centers for Medicare and Medicaid Services "CMS" Inpatient List). They effectively and efficiently manage a diverse...Remote workFull time
- ...Utilization Management And Quality Screening Position Responsible for Utilization Management... .... • While performing utilization review identifies areas for clinical documentation... ...and utilize. • Understanding of Inpatient versus Outpatient surgery and ICD10-Coding...Remote work
$78k - $88k
Gainwell Technologies is seeking a skilled Utilization Review Nurse to perform prior authorization across prospective, concurrent... ..., uses InterQual/MCG criteria, requires 3+ years inpatient experience and an active RN license in the U.S. Core hours 8:00 AM-6:00 PM ET; occasional...Remote job- .... Responsibilities: Reviews documentation and evaluates Potential... ...3+ years of experience as an RN ~ Registered Nurse in state... ...have prior authorization utilization experience ~ Experience... ...MUST HAVE UM experience, inpatient utilization management review...Remote work
$55 per hour
...is hiring a Concurrent Review Nurse to support our client... ...space. Location: Remote (must be based in California... ...concurrent reviews of inpatient activities. This role... ...Experience in case management, utilization management, or... ...judgment within the scope of RN practice in California....Remote workFull timeContract workTemporary workLocal area- ...Position Summary: The RN Integrated Care Coordinator (UM) provides comprehensive care... ...weekend hours are required to address utilization review cases. Roles and Responsibilities Prepares... ...Telecommuting Requirements This is a remote position. Our whole company works remotely...Remote workLive inFlexible hoursWeekday work
$40 - $45 per hour
...you're a clinically driven RN or LPN with utilization management experience and a... ...meaningful coverage decisions, this remote opportunity offers the... ...in medical necessity review and behavioral health services... ...'ll Do • Review assigned inpatient, outpatient, and other...Remote workHourly payTemporary workMonday to Friday$2,000 per week
...RadHealth+ is seeking a travel nurse RN Remote Case Manager, Utilization Review for a travel nursing job in Torrance, California. Job Description & Requirements ~ Specialty: Utilization Review ~ Discipline: RN ~ Duration: 13 weeks ~40 hours per week ~ Shift...Remote workWeekly payFor contractorsLocal areaShift workNight shift
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