Remote Clinical QA Coordinator Utilization Review
AllMed Medical Management
- Remote job
AllMed Medical Management is seeking a Clinical Quality Assurance Coordinator to support 100% remote utilization review services. The role focuses on applying evidence-based guidelines to determine medical necessity and ensure accuracy and regulatory compliance across reviews. The ideal candidate has nursing licensure and experience with URAC or IRO processes, strong medical knowledge, and the ability to work independently within Pacific Time business hours. #J-18808-Ljbffr AllMed Medical Management
- MES Solutions is seeking a Clinical Quality Assurance Coordinator (RN/LPN) to review peer reports and ensure accuracy, compliance with client agreements, and regulatory standards. This 100% remote role aligns clinical expertise with quality control across cases. The position...Remote jobMonday to Friday
- ...Oregon is seeking a Supervisor, Clinical CM to provide operational... ...clinical staff performing utilization reviews and specialty reviews using... ...compliance while coordinating with internal and external... ...This role supports a flexible remote work model with occasional...Remote workFlexible hours
- AllMed is seeking a Clinical Quality Assurance Coordinator (RN) to lead quality utilization reviews and ensure medical necessity in accordance with evidence-based guidelines. The role is 100% remote, requiring a strong knowledge of HIPAA, URAC standards, and regulatory...Remote job
- ...seeking a Registered Nurse for a remote role with Arizona hours (1st shift). You will review medical records for quality, safety, and utilization issues, identify PQIs, and support QA initiatives in... ...license, have 3+ years of clinical experience in med/surg or behavioral...Remote workDay shift
- Dallas Regional Medical Center is seeking aIST Utilization Review/Case Management professional to coordinate clinical reviews of patient records and participate in UR/Case Management meetings. The role requires MPH or related health care training and medical or dental...Suggested
$32 - $46.35 per hour
Olympia Fields Hospital in Olympia Fields, IL, is seeking a full-time Utilization Review professional onsite to coordinate clinical reviews and support case management. The role requires advanced degrees (MPH or equivalent; medical or dental degree) and knowledge of clinical...Hourly payFull time$50k - $60k
Clinical Data And Quality CoordinatorNortheast... ...Data And Quality Coordinator. As an important member... ...with the QA Manager, will be the... ...KPIs, QA Plans, data utilization, monitoring, and... ...clients! This is a remote position, but must... ...with QA Manager to review, quality check,...Remote workFull timeTemporary work- ...Medical Director, Concurrent Review, to evaluate hospitalizations... ...nationwide. The role emphasizes using clinical expertise to determine... ...recommendations. This remote position offers a predictable... ...path to expand knowledge in Utilization Review. Ideal candidates hold...Remote work
$62.4k - $129.38k
...Description: Summary: The Advocacy Clinical Review Coordinator investigates member and provider... ...experience and one (1) year in quality/utilization review; or an LPN with 3 years of appeals... ...note: There may be opportunity for remote work within all jobs posted by the...Remote workFull time- ...ResponsibilitiesCoordinates and completes the clinical reviews for all patient medical records while... ...accounts for multiple levels of Utilization Review and Case Management reporting.... ...care for the continuity of treatment. Coordinates discharge referrals as requested by clinical...Local area
- KVC Health Systems, Inc. in Kansas City, MO is seeking a dedicated Utilization Review Manager (URM) to obtain and review clinical and medical service authorizations, supporting high-quality behavioral healthcare for children and families. You will liaise with treatment...Remote job
- ...Seeking a detail-oriented Clinical Data Quality Coordinator, this full-time remote position requires expertise in data analytics and EHR management to oversee... .... Key responsibilities Collaborate with the QA Manager to review and clean data sets while providing consultative...Remote workFull time
- ...Health Corporation is seeking an RN Concurrent Review Nurse to join a remote team delivering inpatient clinical expertise to ensure medically necessary care across... ..., 5+ years inpatient nursing, and 2+ years in utilization management or discharge planning, with an Associate...Remote jobWork from homeMonday to FridayWeekend work
- A peer review organization is seeking a full-time remote Utilization Management Physician Reviewer. Ideal candidates must hold an MD, DO, or DPM degree with active... ...with management and providing guidance on clinical questions. This is a unique opportunity to work from...Remote jobFull timeWork from home
- MES Solutions is seeking a self-driven RN or LPN to join as Clinical Quality Assurance Coordinator, working 100% remotely. You will review peer review reports, ensure clinical rationales are evidence-based, and verify compliance with client agreements and regulatory standards...Remote job
- Spectrum Billing Solutions is seeking an ABA Utilization Review Specialist to review clinical information and obtain authorizations for ABA and related services. This role supports remote or office/home hybrid work and emphasizes attention to medical necessity and HIPAA...Remote jobWork at officeWork from home
- ExamWorks, Inc. is seeking a Clinical Quality Assurance Coordinator to review peer reports for quality, accuracy and regulatory compliance. This 100% remote role targets nurses with peer review or... ...exposure. Responsibilities include QA reviews, evidence-based rationales...Remote job
$32 - $46.35 per hour
Overview Department: Utilization Review Shift: Full-Time, On-Site Facility: Olympia Fields Hospital Location: Olympia Fields, Illinois 60461 Responsibilities Coordinates and completes the clinical reviews for all patient medical records while working closely with CMO...Hourly payFull timeLocal areaShift work- ...LLC is seeking an experienced Sr Review Coordinator for our healthcare consulting practice. This fully remote role within the United States focuses on utilization review of plans of service for... ...-based programs, supporting non-clinical reviewers, and ensuring timely,...Remote jobWork from home
$219k - $286.9k
Oscar Health is hiring a Physician Reviewer to join our Utilization Management team. You will determine the medical... ...outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines. This remote role in the United States offers work...Remote jobWork from home$100.16k - $218.72k
...visibility Work Location: Santa Monica, CA, USA Onsite or Remote Fully On-Site Work Schedule 8:00 AM - 4:30PM Posted Date... ...UCLA Health is seeking a detail‑oriented and mission‑driven Clinical Data Review Coordinator to support our quality reporting and regulatory...Remote workHourly payWork at office- Clinical Communication - Delegated and Supervised Answer... ...Communicate provider-reviewed test results to patients... ...EMR and triage system Coordinate follow-up on labs,... ...or procedures Triage QA And Escalation Identify... ...and multitasking in a remote or multi-clinic setting...Remote workFull timeWork at officeImmediate start
- Comagine Health is seeking a Clinical Reviewer with LCSW/LPC/LCPC licensure for a remote, Oregon-based role requiring travel... ...medical necessity and coordinate in-home and community-based care... ...populations. The position emphasizes utilization review, documentation, and collaboration...Remote jobWork from home
- ...Remote DUR Pharmacist Safe & Cost-Effective Medication Use Work From Home Analyze medication use patterns, apply clinical guidelines, and collaborate with providers all from home. This remote Drug Utilization Review Pharmacist role is ideal for pharmacists who enjoy...Remote jobWork from home
- ...the pioneer in Contactless Remote Patient Monitoring (RPM), proven... ...Overview: The Field Clinical Coordinator plays a key role in... ...nurses, to ensure the effective utilization of clinical systems and devices... ...performing basic patient reviews for stable patients Maintain...Remote work16 hoursShift work
- ...Northpoint Recovery Holdings, LLC is seeking a licensed Utilization Review Specialist to ensure clinically appropriate care, discharge planning, and cost-effective utilization across the treatment continuum. You will lead reviews of admissions, stays, discharges, and...Remote work
- ...Centene Corp. is seeking an Utilization Review Clinician - Behavioral Health to conduct clinical reviews for mental health and substance use services, ensuring appropriate... ...level of care for Oregon Medicaid in a fully remote role. The position follows a Monday–Friday 8–...Remote workMonday to Friday
- ...to support retail pharmacy operations remotely. This role involves processing... ...prescriptions, performing prior authorization reviews, and coordinating care for patients. Candidates should... ...pharmacy, ideally with experience in utilization review. A strong knowledge of...Remote work
- ...Medix is seeking a highly skilled Utilization Review Nurse Specialist for a fully remote role in the United States. The RN will assess medical necessity and... ...Experienced RNs with ICU/ED/OR background, strong clinical judgment, and a mindset that embraces AI tools to streamline...Remote work
- ...Allegheny Health Network seeks an RN Utilization Review professional to obtain pre-certifications, coordinate authorizations and manage denials for a seamless patient... ...appropriate levels of care and timely approvals. This remote role requires PA RN licensure (or multi-state...Remote work
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