Remote Clinical Reviewer - Utilization Review
Comagine-Health
Comagine-Health is hiring a Clinical Reviewer based in Washington DC. This full-time remote/hybrid position will assess the medical necessity and quality of healthcare services. Ideal candidates have 3 years of clinical experience and an active RN license. The role involves reviewing clinical documentation, collaborating with teams, and ensuring compliance with health standards. Benefits include insurance, paid time off, and a retirement plan. This is a fantastic opportunity for a dedicated professional to enhance healthcare outcomes remotely. #J-18808-Ljbffr
- ...Excellus BCBS is hiring for a Utilization Management position based in... ...The ideal candidate will have clinical experience, strong... ...performing pre-service clinical reviews and collaborating with healthcare... ...salary range and potential for remote work based on departmental needs...Remote work
- ...NYS RN license and 3+ years of clinical experience. Responsibilities include clinical reviews and collaboration with providers... ...Preferred candidates will have utilization management experience and... ...based on experience, and potential for remote work. #J-18808-Ljbffr...Remote work
- ...physical health services in Town of De Witt, NY. The position demands extensive clinical experience and knowledge of utilization management, with responsibilities including performing clinical reviews and collaborating with providers. Applicants should possess an Associate...Remote work
$50 per hour
GreenLife Healthcare Staffing is looking for an experienced Registered Nurse Clinical Reviewer for a fully remote position with an hourly rate of $50. This role involves conducting utilization reviews and ensuring healthcare documentation compliance for a respected non-...Remote jobHourly pay$45 - $50 per hour
Greenlife Healthcare Staffing is looking for a dedicated Registered Nurse Clinical Reviewer for a fully remote position in New York. This role involves conducting utilization and quality reviews and contributing to clinical studies. With a competitive pay of $45 - $50...Remote jobHourly pay- ...coordinate behavioral health services for members, ensuring adherence to all necessary standards. The role involves performing clinical reviews, collaborating with healthcare providers, and advocating for member needs. Ideal candidates will have at least 3 years of...Remote work
- ...This role requires a minimum of three years clinical experience and a valid NYS RN license. The position involves clinical reviews ensuring compliance with health standards. Applicants... ...with Microsoft Office. Opportunities for remote work may be available based on departmental...Remote workWork at office
- ...improve care delivery and patient outcomes. Our talented remote workforce spans the country and plays a vital role in our... ...much more! Position Overview We are seeking a Clinical Utilization Review Nurse (RN) to assess the medical necessity and quality of...Remote workFull timeContract workWork at officeWork from home
- ...Behavioral Health Services Reviewer Are you passionate about improving... ...? Do you enjoy using your clinical expertise to evaluate needs,... ...evidence-based criteria to utilization management reviews; document... ...success on this team. This is a remote position based in Oregon and...Remote workFull timeContract workWork from home
- ...passionate about using your clinical expertise to support quality... ...services? Do you enjoy critically reviewing clinical documentation,... ...are recruiting for 5 full-time remote/hybrid Clinical Reviewer positions... ...Reviewer position supports utilization management activities by...Remote workFull timeWork from homeMonday to Friday
- ...Title: Clinical Reviewer Location: Remote Work Duration: 03 Month contract (Extension possible) Job Description: The purpose of this position is to utilize clinical expertise to review medical records against appropriate criteria in conjunction with contract...Remote workContract workFlexible hours
- ...focuses on behavioral health and requires a strong background in clinical experience, compliance with standards, and effective... ...and have proficiency in Microsoft Office. This role may involve remote work opportunities depending on departmental needs. #J-18808-Ljbffr...Remote workWork at office
$52.12k - $78.87k
Description * Position is Eligible for Remote / Work from Home Opportunity *... ...noridiansolutions.com) Job Title Clinical Reviewer (RN) Job Summary The Clinical Reviewer... ...standards of care ~1 year experience utilization review or case management ~1 year...Remote workFor contractorsCasual workWork at officeLocal areaWork from homeFlexible hours$28.37 - $35 per hour
...outcomes through technology, services, and clinical expertise. Our mission is to innovate health... ...Acentra seeks a Clinical Reviewer to join our growing team. Job Summary: The Clinical Reviewer utilizes clinical expertise during beneficiary interaction...Remote workContract workWork at officeLocal areaMonday to FridayFlexible hoursShift workWeekend work$30 - $40 per hour
...Appeals Clinical Reviewer The Appeals Clinical Reviewer serves as an Appeals Utilization Review Nurse responsible for reviewing and evaluating member and provider appeals... ...of healthcare services. This is a remote opportunity with potential for permanent placement...Remote workPermanent employmentContract workTemporary workWork at officeWork from homeMonday to Friday- ...Clinical Utilization Review Nurses (RN) Based In Alabama Comagine Health is a national, mission-driven, nonprofit organization that has engaged... ...improve care delivery and patient outcomes. Our talented remote workforce spans the country and plays a vital role in our...Remote workFull timeContract work
$68k - $71.03k
...Claims Clinical Documentation Reviewer Job No: 541748 Work Type: Full-time Location: REMOTE OPTIONS, VARIOUS-STATEWIDE, PHOENIX Categories: Research, Social... .... Monitor over and under service utilization, conduct prepayment claims reviews, provide...Remote workFull timePart timeInternshipWork at officeWork from homeLong distanceFlexible hours$50 per hour
...Overview RN Clinical Reviewer / IDR - Remote (#25310C) Location: Remote Employment Type: Full-time Hourly Rate: $50/hr Position Overview Greenlife... .... Must have 1-3 years of experience in acute care utilization review/ appeals background. Technical Skills: Experience...Remote workHourly payFull timeWork at officeFlexible hours- ...'s more than a career, it's a calling. MO-REMOTE Worker Type PRN Job Summary Performs concurrent analytical reviews of clinical and coding data to improving physician documentation... ...reconcile the DRG and resolves mismatches utilizing the escalation policy. Troubleshoots...Remote workHourly payDaily paidTemporary workReliefFlexible hoursShift work
- ...Clinical Quality Reviewer Ensures compliance with the contract, and program requirements for Clinical Quality Management (CQM) within West... ...records retrospectively for potential quality, safety, and utilization issues by using organizational, national, and URAC standards...Remote workContract workInterim role
- ...federal healthcare program to identify a Clinical Quality Reviewer. This role focuses on reviewing... ...with experience in clinical review, utilization management, or healthcare quality within... ...driven environment Other Information Remote or onsite depending on business needs...Remote workWork at officeHome office
- ...customer inquiries in health insurance. This role emphasizes excellence in service and compliance, with necessary experience in a clinical or health-related field. Candidates must hold a relevant degree or behavioral health license and have at least two years of relevant...Remote jobWork experience placement
- ...A leading insurance provider in Omaha, Nebraska is seeking a full-time Utilization Review Nurse to ensure effective management of injured workers' treatments. This role does not require prior utilization review experience and is perfect for skilled nurses looking to transition...Remote workFull timeWork at officeWork from home
- ...steps. Our partner is looking for a Clinical Appeals Reviewer (Licensed Healthcare Professional) based... ...the United States. This is a fully remote clinical decision-making role focused... ...in medical review, Medicare appeals, utilization review, or related clinical decision-...Remote workContract workFlexible hours
- ...Medix™ is seeking an experienced RN for a Utilization Review role, allowing you to work from the comfort of home. In this contract-to-hire position, you'll review inpatient treatment plans and communicate with medical teams to ensure appropriate care levels. Ideal candidates...Remote workContract workWork from home
$28.37 - $35 per hour
...Health in McLean, Virginia, is looking for a qualified nurse to review medical records and ensure compliance with contract... ...hold a valid LPN, LVN, or RN license and have at least 1 year of Utilization Management experience. This role offers competitive pay ranging...Hourly payContract work$62.7k - $100.4k
Job Summary Clinical Care Reviewer II is responsible for processing medical necessity reviews for appropriateness of authorization for health... ...acute clinical care or home health experience preferred Utilization Management/Utilization Review experience preferred Medicaid...Remote jobWork at office$75k
...Cottage Hospital is seeking a dedicated Registered Nurse for inpatient utilization review responsibilities. This role requires performing medical necessity reviews and collaborating with clinical teams to make informed decisions. Candidates must hold an active RN license...Remote 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 workFull timeWork from home
$30 - $45 per hour
...and Medi-Cal operations, along with experience in Epic EHR and Utilization Review. The selected candidate will perform chart reviews, ensure... ...accuracy, and support Medicaid program metrics. This position is remote and offers a pay range of $30-$45 per hour with various...Remote workHourly payContract work
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