Remote UM Nurse Consultant: Medical Review

Santa Barbara Cottage Hospital

Remote job

American Health Holding, Inc. (AHH) offers a fully remote Utilization Management Nurse Consultant role focused on medical review for members. You will apply clinical judgment to assess necessity and collaborate with providers to ensure timely care. This desk-based position rewards precision, communication, and compassionate patient interaction. Required RN licensure with multistate privileges and 3+ years of clinical experience; 1+ year in utilization review and a 3-week mandatory training are #J-18808-Ljbffr Santa Barbara Cottage Hospital

Apply

Vacancy posted 3 days ago

Similar jobs that could be interesting for youBased on the Remote UM Nurse Consultant: Medical Review in New York, NY vacancy

Remote Utilization Review Nurse (LPN/LVN) - UM & Appeals
...Integra Partners is seeking a licensed Practical Nurse (LPN/LVN) experienced in managed care UM to perform pre-service and post-service utilization reviews and appeals for DMEPOS, working with our Medical Director in a NCQA-compliant UM program. You will review benefit...
Remote work
Medical
Santa Barbara Cottage Hospital
New York, NY
2 days ago
RN- Care Review Clinician- UM/Discharge Planning (Remote- CA License Req)
...for clinical member services review assessment processes. Responsible... ...verifying that services are medically necessary and align with established... ...to utilization management (UM) policies and procedures.... ...and experience. Registered Nurse (RN). License must be active and...
Remote job
Medical
Work at office
Molina Healthcare
Los Angeles, CA
3 days ago
Remote Medical Claim Review Nurse (RN/Appeals)
Walker Healthforce, LLC seeks a Medical Claim Review Nurse for a fully remote contract based in Washington. The role focuses on retrospective medical necessity... ...(ICD-10, CPT, HCPCS) and proficiency in PEGA A&G, PEGA UM, or QNXT. #J-18808-Ljbffr Walker Healthforce, LLC
Remote job
Medical
Contract work
Walker Healthforce, LLC
Bothell, WA
2 days ago
Remote Utilization Management Nurse: Medical Review
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 job
Medical
Work at office
Brighton Health Plan Solutions
New York, NY
4 days ago
Utilization Management Nurse Consultant - Medical Review (Remote)
$26.01 - $56.14 per hour
...0am-5:00pm EST Location: 100% Remote (U.S. only) About Us American... ...CVS Health, is a URAC-accredited medical management organization founded... ...journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review, you’ll play a vital role in...
Remote work
Medical
Hourly pay
Full time
Temporary work
Local area
Monday to Friday
Flexible hours
Shift work
Santa Barbara Cottage Hospital
New York, NY
3 days ago
Nurse Consultant
...professionals, including doctors, nurses, business people, tech... ...drive groundbreaking medical discoveries and invite... ...quality and safety.Review and evaluate clinical... ..., or healthcare consulting 5-7 years requiredKnowledge... ...Hearing Constantly (67-100%)Remote TypeHybridWork Location...
Remote work
Medical
Local area
Mass General Brigham
Belmont, MA
1 day ago
Remote Utilization Nurse Consultant — Precertification
...seeking an experienced Utilization Management Nurse for precertification in a remote, full-time role with a 40-hour work week. You will review clinical information, apply guidelines,... ...while coordinating with providers and Medical Directors to ensure timely coverage decisions...
Remote job
Medical
Full time
Hispanic Alliance for Career Enhancement
Denver, CO
3 days ago
Medical Claim Review Nurse | Remote | Washington | Contract
Back Medical Claim Review Nurse | Remote | Washington | Contract Business & Care Management Long Beach , California... ...Experience using PEGA A&G, PEGA UM, or QNXT Utilization Management... ...and interview preparation Ongoing consultant support throughout your assignment...
Remote job
Medical
Contract work
Work at office
Immediate start
Monday to Friday
Walker Healthforce, LLC
Bothell, WA
2 days ago
Concierge Nurse Consultant
...GBCARE division is looking for a nurse to join its Clinical Concierge... ...proactive management of the medical treatment process from day one... ...and other support staff. Reviews medical records post appointment... ..., supporting the nurse #LI-REMOTE Compensation and benefits...
Remote work
Medical
Local area
Arthur J. Gallagher & Co.
Franklin, TN
1 day ago
Immunization Nurse Consultant
$76.82k - $101.88k
...health districts. Provide consultation and guidance to state... ...local public health nurses and professionals on... ..., and complete annual review and revision of section... ...description for this job Medical insurance Vision... ...ago Registered Nurse (Remote Patient Monitoring and...
Remote work
Medical
Full time
Part time
For contractors
Local area
Relocation package
Flexible hours
Night shift
Georgia Department of Public Health
Atlanta, GA
1 day ago
Utilization Review Nurse Corporate UM
...field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical... ...Corp Utilization Management Location: Bala Cynwyd, PA/ remote Summary The Utilization Review Nurse is responsible for conducting timely and accurate...
Remote work
Medical
Penn Medicine, University of Pennsylvania Health System
Bala Cynwyd, PA
1 day ago
UM RN Care Review Clinician
$40 - $42 per hour
...staffing agency currently looking for a Care Review Clinician I to work with our Managed... ..., Rotating Holidays ***This is a fully remote role but candidates must have a valid RN... ...Management team primarily responsible for medical necessity/utilization review aimed at...
Remote work
Medical
Hourly pay
Local area
Monday to Friday
AltaStaff, LLC
Chicago, IL
19 days ago
Senior Consultant (Source Code Review)
$80 - $100 per hour
...Senior Consultant – Source Code Review (IP Litigation)responsible for deep-dive firmware, driver, kernel... ...Part-time, exempt Work Arrangement: Remote, US-based Location: Candidates may... ...Health & Well-being: We offer robust medical, dental, and vision insurance options...
Remote work
Medical
Hourly pay
Permanent employment
Contract work
Part time
Worldwide
Flexible hours
Lumenci
United States
2 days ago
Utilization Management (UM) Nurse Consultant - Work at Home in EST Zone
$26.01 - $56.14 per hour
...time. Utilization Management (UM) Nurse Consultant 100% Work‑From‑Home | Full-... ...our team. This is a fully remote role available to candidates... ...turnaround times. This role involves reviewing clinical documentation,... ...): Reviewing services for medical necessity and appropriate...
Remote work
Medical
Hourly pay
Full time
Temporary work
Work at office
Local area
Work from home
Monday to Friday
Shift work
Weekend work
CVS Health
Raleigh, NC
5 days ago
International Nurse Consultant
...International Consultant As an International Consultant... ...standards, including reviewing clinical and... ...individual's health status. Nurse: Graduate of an... ..., and push to inspect medical facilities, equipment,... ....g., emergency exits, remote storage areas, infection...
Remote work
Medical
Contract work
Currently hiring
Long distance
Flexible hours
The Joint Commission
Oak Brook, IL
3 days ago
DRG Quality Advisor Nurse- Remote
...DRG Quality Advisor Nurse- Remote Date: Jul 29, 2026 Location: Any city, MO, US, 99... ...Virtual (Exception only) It takes great medical minds to create powerful solutions that... ...assurance audits, complex clinical review validation, and DRG clinical/coding audits...
Remote work
Medical
Contract work
Temporary work
Work from home
Flexible hours
ESR Healthcare
Missouri
16 days ago
Remote Dental UM Clinician — Prior Authorizations and Reviews
...Management Clinical Dental Processor to review dental x-rays and patient histories, ensuring medical necessity for prior authorizations. You will work remotely, complete 13-18 cases per hour, and... ...histories, and collaborate with the UM team to optimize processes. Overtime...
Remote job
Medical
Hourly pay
Avesis Incorporated
Brooklyn, NY
5 days ago
Regional Immunization Nurse Consultant
$66.7k - $110.05k
...Nurse Consultant II (NS) The North Carolina Department of Health and Human... ...Conduct VFC site visits to medical provider offices to assess... ...Position Is Eligible For A Fully Remote Work Option Physical... ...Orders. We are committed to reviewing requests for reasonable accommodation...
Remote work
Medical
Work experience placement
Private practice
Work at office
Local area
Night shift
North Carolina
Raleigh, NC
3 days ago
Review Nurse-PA/UM
...Are you a bedside nurse seeking a change from the hospital... ...is recruiting a Hybrid Review Nurse for its Prior... ...Management (PA/UM) team. The Review Nurse... ...review by a Peer Review Consultant on any case which a nurse... ..., Supervisor PA/UM, or Medical Directors on issues related...
Medical
Contract work
Alliant Health Group
Atlanta, GA
4 days ago
Design Review Support Specialist [DOE0123122]
...a Management and Operations Consulting Services Firm focusing on providing... ...Seeks a Design Review Support Specialist [DOE012312... ...Subject to Change or Working Remotely): 2440 Stevens Center Place,... ...Performance Incentives. For medical and dental benefits, the Company...
Remote work
Medical
Full time
Contract work
Temporary work
For contractors
For subcontractor
Work at office
Flexible hours
Prosidian Consultng
Richland, WA
2 days ago
Remote Utilization Review Nurse
$90k - $107k
...Brigham Health Plan Holding Company, Inc. is seeking a Remote UM Nurse to support network adequacy review and authorization activities for members in ACO, HMO... ...to review prior authorization requests, assess medical necessity, and render decisions within scope. The position...
Remote work
Medical
your Jared
Brooklyn, NY
5 days ago
Remote Utilization Review Nurse
...Solutions, LLC is seeking an Utilization Management Nurse to perform medical necessity reviews remotely. Licensed LPN with strong MS Office skills will review... ...in compliance with standards. Two or more years in a UM team within managed care is preferred, as is nurse experience...
Remote work
Medical
Brighton Health Plan Solutions
Chapel Hill, NC
4 days ago
RN Utilization Review
...– St. Bernardine Medical Center is a 342-bed... ...Responsible for the review of medical records... ...physician, consultants, second level physician... ...Job Requirements Remote. Must reside... ...Case Management or Nursing field in lieu of 1... ...Manager (ACM-RN), or UM Certification #J...
Remote work
Medical
Santa Barbara Cottage Hospital
New York, NY
4 days ago
Registered Nurse Utilization Review
...highly skilled and experienced Registered Nurse with specialties in Medical/Surgical, ICU, ER, Psychiatric, Labor... ...Experience in Utilization Review or case management roles. Specialty... ...Strong ability to work independently in remote settings. Must be able to handle...
Remote work
Medical
Flexible hours
vTech Solution
Santa Rosa, CA
4 days ago
Review and Evaluation Nurse (RN) - Critical Incident Management Unit
...Job TitleRegistered Nurse (RN) for Critical Incident Management... ...you will be responsible for reviewing and evaluating critical incidents... ...with each participant's medical and functional needs. You will... ...utilizing technology to support remote and hybrid work functions....
Remote work
Medical
Work from home
The CKHobbie Group
Harrisburg, PA
3 days ago
Registered Nurse - Utilization Review (Nursing)
$1,600 - $1,800 per week
...Now Hiring: Registered Nurse – Utilization ManagementLocation: Buckley... ..., no holidays, no telehealth/remote workMinimum QualificationsU.S.... ...Management, Utilization Review, or Case ManagementPreferred Certifications... ..., Case Management, or Medical-Surgical (ANCC or NCQA)...
Remote work
Medical
Contract work
Immediate start
Monday to Friday
J Edward Staffing LLC
Aurora, CO
2 days ago
Care Review Clinician (RN) Remote
$23.76 - $51.49 per hour
...for clinical member services review assessment processes. Responsible... ...verifying that services are medically necessary and align with established... ...to utilization management (UM) policies and procedures.... ...education and experience. Registered Nurse (RN). License must be active...
Remote work
Medical
Hourly pay
Work experience placement
Work at office
Molina Healthcare
Brooklyn, NY
2 days ago
Remote RN - Clinical Access & Utilization Review
...management team from home in Pennsylvania. The role supports medical necessity reviews and level of care determinations. You will review cases,... ...outcomes. Requires at least 3 years of RN experience and preferably UM background. #J-18808-Ljbffr Santa Barbara Cottage Hospital
Remote job
Medical
Daily paid
Santa Barbara Cottage Hospital
New York, NY
4 days ago
RN - Suicide Mortality Review Nurse Abstractor
...Nurse AbstractorThe Suicide Mortality Review (SMR) Program, within the Arizona Department of Health Services' Office... ..., including but not limited to medical, behavioral health, law enforcement... ...communication within a multidisciplinary remote team.QualificationsEducation:...
Remote work
Medical
Work at office
Compu-Vision Consulting
Phoenix, AZ
5 days ago
HEDIS Review Nurse - Remote - Contract
...Review NurseThis is a contract assignment that will start right away and end on April 30th 2024Summary Description:The review nurse is responsible for medical record abstractions and overreads during the annual Healthcare Effectiveness Data and Information Set (HEDIS)...
Remote work
Medical
Contract work
Immediate start
HireOps Staffing LLC
Dallas, TX
14 hours ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Remote UM Nurse Consultant: Medical Review. Be the first to apply!