Remote Utilization Management Nurse Consultant
CVS Health
- Remote job
CVS Health is seeking a highly experienced Utilization Management (UM) Nurse Consultant for a 100% work-from-home role within the CST zone. The position emphasizes reviewing clinical documentation, coordinating care, and ensuring timely, appropriate benefits determinations while meeting regulatory requirements. You will collaborate with providers, document complex cases, and support cost-effective, quality care delivery. Active RN license and 2+ years hospital experience required. #J-18808-Ljbffr CVS Health
- ...CVS Health is seeking a Registered Nurse for Utilization Management on a work-from-home schedule with weekend coverage. You will assess, plan, implement, coordinate, monitor, and evaluate options to facilitate healthcare services and member benefits. Responsibilities...Remote workWork from home
- ...CVS Health is seeking an experienced Utilization Management Nurse Consultant for a 100% work-from-home, full-time position open to MST/PST residents. You will coordinate and document utilization and benefit management activities, ensuring timely, safe, and appropriate...Remote workFull timeWork from home
- ...Health Corporation is seeking an experienced Registered Nurse for Utilization Management. The role examines and coordinates care options, applying... ...a 24/7 environment with weekends, holidays and evenings. Remote work is supported for colleagues who live in-state, with...Remote workLive inHome officeWeekend workAfternoon shift
$32.01 - $68.55 per hour
..., each and every day. Position Summary This Utilization Manager position is with Aetna's Long-Term Services and Supports (LTSS) team and is a fully remote role. Candidates must hold a New York Registered Nurse license. The employee will work four 10-hour days...Remote workHourly payFull timeLocal area10 hours per weekFlexible hours$26.01 - $68.55 per hour
...Utilization Management Nurse - Precertification RN Remote | Full-Time | Weekday Schedule Are you a clinically strong Registered Nurse who enjoys critical thinking and making evidence-based decisions? Join our Utilization Management team and play a key role in ensuring...Remote workHourly payFull timeTemporary workLocal areaWeekday work$26.01 - $68.55 per hour
...one person, one family and one community at a time. Fully remote with requirement to work the following schedule: Monday-Friday 8:00am-4:30pm EST. Position Summary As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and...Remote workHourly payFull timeTemporary workWork at officeLocal areaMonday to FridayWeekend work$26.01 - $56.14 per hour
...Utilization Management PositionWe're building a world of health around every individual — shaping... ...Healthcare Services and benefit utilization.Consults and lends expertise to other internal... ...+ years of experience as a Registered Nurse in adult acute care/critical care...Hourly payFull timeTemporary workWork at officeWork from homeAfternoon shift$29.1 - $62.32 per hour
...determined in collaboration with management to ensure adequate weekend coverage. Position Summary Utilize your clinical experience and... ...and benefit utilization. Consult and lend expertise to other internal... ...Qualifications Registered Nurse Education: Diploma RN acceptable...Hourly payFull timeTemporary workWork at officeLocal areaWork from homeShift workWeekend work$29.1 - $62.32 per hour
...UM Nurse ConsultantWe're building a world of health around every individual — shaping... ...family and one community at a time.Utilization Management is a 24/7 operation and work schedule... ...holidays, and evening hours.The UM Nurse Consultant utilizes clinical experience and...Hourly payFull timeTemporary workWork at officeWork from homeAfternoon shift- ...Utilization Management Nurse ConsultantIntegrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected... ...of Healthcare Services and benefit utilization· Consults and lends expertise to other internal and external constituents...Work at officeWeekend work
$32.01 - $68.55 per hour
...Utilization Management Position We're building a world of health around every individual — shaping... ...Services and benefit utilization Consults and lends expertise to other internal... ...+ years of experience as a Registered Nurse in adult acute care/critical care setting...Hourly payFull timeTemporary workWork at officeAfternoon shift- ...Spectrum Healthcare Resources is seeking a Utilization Manager Registered Nurse (UMRN) to work entirely remotely from home. The nurse will review cases, educate patients on appropriate care, and manage health care costs for dependents of Active Duty and eligible retirees...Remote workWork from homeMonday to Friday
- ...Humana is seeking a Manager, Utilization Management Nursing to lead coordination and interpretation of medical services and benefit determinations in a remote, home‑based role. You will apply advanced nursing knowledge, guide teams, and collaborate across departments...Remote workWork from home
- ...Quality Management Utilization Review Consultant Registered Nurse The Quality Management Utilization Review Consultant Registered Nurse delivers knowledge-based care to assigned clients while developing technical skills. Assesses, plans, implements, and evaluates care...
- ...UnitedHealth Group is seeking a Utilization Management Nurse to ensure efficient and effective health services delivery across care settings. You... ...decisions to help members live healthier lives. This role offers remote work with time-zone requirements in Pacific or Mountain...Remote work
- ...IntePros is seeking a Physician Reviewer to provide remote support for a healthcare organization. The role involves reviewing... ...This position offers a collaborative environment with opportunities to leverage clinical expertise in utilization management. #J-18808-Ljbffr...Remote work
- ...Santa Barbara Cottage Hospital is seeking an experienced Utilization Management Nurse Consultant for a remote role with the Spine Team. You will review spine-related authorizations, apply criteria, and collaborate with providers and Medical Directors to ensure medically...Remote work
- ...Optum is seeking an experienced Utilization Review Nurse (RN) to support inpatient care management in a remote-capable role. You will review admissions and preauthorizations using evidence-based criteria and collaborate with Medical Directors. The position requires an...Remote work
$59.5k - $116.6k
...UnitedHealth Group is seeking a Utilization Management Nurse RN to work remotely from anywhere in the U.S. This role involves ensuring efficient health services and requires an active RN license and 3+ years of Managed Care or Clinical experience. The successful candidate...Remote workWeekend work- ...UnitedHealth Group is seeking a Utilization Management Nurse to help ensure high-quality, cost-efficient care across the continuum. You will assess... ...levels of care in collaboration with care teams. This remote role requires Pacific or Mountain Time Zone residence. You...Remote work
- A healthcare staffing agency seeks a Utilization Management RN to evaluate clinical conditions through medical record reviews. The position is remote, requiring candidates to reside in PA, DE, or NJ. Key duties involve applying criteria for medical necessity, collaborating...Remote work
- ...Devoted Health is seeking a Clinical Guide for our Outpatient Utilization Management team. You will perform timely clinical reviews of outpatient... ...medical necessity and appropriate setting. This full-time, remote role supports CMS and Medicare Advantage requirements while...Remote workFull time
- ...Plan Holding Company, Inc. is seeking a UM Nurse to support network adequacy review and... ...for ACO, HMO, and EPO products. Remote role with occasional onsite meetings in... ...Requires MA RN license and 2–3 years of utilization review experience. You will review authorization...Remote work
- ...Humana Inc. is seeking an Utilization Management Nurse 2 to apply clinical nursing skills in coordinating, documenting, and communicating medical... ...independent decisions aligned with organizational strategy. Remote-friendly, standard hours, with occasional travel. #J-18808...Remote work
- ...A leading independent review organization is seeking a Utilization Management Physician Reviewer for a full-time remote role. Candidates must possess an active Nebraska medical license and have a minimum of 5 years clinical practice experience. Responsibilities include...Remote workFull timeCasual workMonday to Friday
- ...Registered Nurse - Utilization Review About Company Bestica: We at Bestica believe our success is a direct result of hard work and outstanding employee dedication. Our environment is dynamic, friendly, and collaborative. We foster a positive culture, where innovation...Remote work
- ...UVA Health is seeking a Registered Nurse (RN) in Utilization Management for a remote role. You will leverage acute care experience to navigate complex clinical scenarios, determine medical necessity, and collaborate with interdisciplinary teams. This position offers a...Remote workRelocation packageMonday to FridayWeekend work
- ...OncoHealth is seeking an UM Trainer to design, coordinate, and deliver training programs for the Utilization Management team. This role supports onboarding, development, and ongoing education to ensure compliance with regulatory and client requirements. The UM Trainer...Remote work
- ...Managing patient admissions and medical necessity reviews, the full-time Florida Licensed Utilization Management RN will work remotely to ensure compliance with payer guidelines, collaborate with... ...qualifications Associate's degree in Nursing (Required); Bachelor's degree...Remote workFull time
$70k - $75k
...Utilization Management Registered Nurse (RN) - Remote Full-time WHO IS GUIDEHEALTH? Guidehealthis a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients,...Remote workBi-weekly payFull timeTemporary workFor contractorsLocal areaWork from home
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