Remote Utilization Management RN - Quality Care
WPS Health Solutions
- Remote job
WPS Health Solutions seeks a Utilization Management RN to assess medical necessity and authorize services using evidence-based criteria. You will refer cases to medical directors to prevent unnecessary procedures and collaborate with Health Services and Medical Directors to optimize care. The role requires 4+ years of RN experience, 2+ years in Managed Care, and strong analytical and communication skills. Remote work options available within approved states, with comprehensive benefits. #J-18808-Ljbffr WPS Health Solutions
- ...provider in Chicago is hiring a Clinical Care Manager to oversee high-quality, patient-centered care through Utilization Review. The role requires an active RN license in Illinois and significant... ...position offers the flexibility of remote work while supporting professional...Remote workQuality
- ...regional Coordinated Care Organization (CCO) for... ...Together. This is a remote position in which we are... ...: ~ ~ Health plan utilization management ~ Medicare and Medicaid... ...improvement plans ~ Quality Management experience... ...unencumbered Oregon RN License required within...Remote workQuality
- ProMedica is seeking a Utilization Management RN for a remote, part-time role in Ohio with a 20-hour work week. You will review admissions and transfers... ...with clinicians to optimize resource use and care quality. Qualifications include a NLN-accredited nursing program...Remote jobQualityPart timeWork from home
- ...appropriate reimbursement, and high-quality patient care across skilled nursing and... ...with some flexibility for remote work based on business... ...~ Active, unrestricted RN license in the state of Massachusetts... ...~ Experience in utilization management, medical record review, or...Remote workQualityWeekend workWeekday work
- ...looking for a Registered Nurse for Utilization Management, primarily focused on benefit... ...-related services. This role is remote, requires an Oregon RN license, and offers competitive... ...regulations, geared towards ensuring quality patient care. #J-18808-Ljbffr CareOregon,...Remote jobQuality
- ...Utilization Management Team Member Responsible for clinical review of utilization requests and assessment... ...of potential coordination of care opportunities for overall membership, institutionalized... ...Appropriately identifies and refers quality issues to Medical Management leadership...Remote workQuality
- CommonSpirit Health is seeking a Supervisor of Utilization Management (UM). This remote position requires overseeing the Pre-Authorization team while... .... Your leadership will be essential in promoting quality patient care. The ideal candidate will have significant...Remote jobQuality
- WPS Health Solutions is seeking an Utilization Management RN to evaluate medical necessity and efficiency... ...are not met. The position supports remote work in approved states, including... ...functional collaboration and maintaining quality care while controlling costs. #J-18808-...Remote jobQuality
- ...Solutions in the United States is seeking an experienced Utilization Management RN to evaluate medical necessity and authorize... ...judgment and evidence-based criteria to support quality care while controlling costs. Remote work is available in many states; expect...Remote jobQuality
- ...experienced nurse for complex case management and medical necessity determinations... ...and the Medical Director to ensure quality care and appropriate utilization. The role emphasizes nursing... ...cross-functional collaboration, with remote work options and a hybrid attendance...Remote jobQuality
- ...Barbara Cottage Hospital is seeking a Per Diem RN for Utilization Management Review. This role offers the flexibility of remote work and requires a valid MA Registered... ...candidate will participate in ensuring quality patient care through thorough utilization reviews. Responsibilities...Remote jobQualityDaily paid
$39 - $40 per hour
...Recruiter at The Judge Group Utilization Management Registered Nurse (RN) Type: 6-Month Contract W2 Location: Remote - but MUST reside in one of the... ...services, coordinating care, and ensuring members receive high-quality, cost-effective treatment. Responsibilities...Remote workQualityDaily paidContract workMonday to FridayShift workWeekend work- ...is seeking a Clinical Manager for Care Management with a passion... ...leadership. This fully remote role focuses on driving... ...will possess an active RN license, extensive experience in utilization management, and strong... ...Join us in providing high-quality, patient-centered care...Remote jobQuality
- Comagine Health is seeking a Clinical Manager, Care Management to lead a team in utilization management from a fully remote position in the U.S. The ideal candidate will have... ...settings and will be responsible for clinical quality, operational performance, and staff...Remote jobQuality
$75.3k - $135.4k
...professional on our Medical Management/Health Services... ...appropriate care to members.... ...day activities of utilization management team. Monitors... ..., compliance, quality, and efficiency standards... .../Certification RN - Registered Nurse... ...to work with remote, hybrid, field or...Remote workQualityFull timePart timeWork at officeFlexible hours$45 - $45.5 per hour
...Job Title: Nurse Case Management Senior Analyst Location: REMOTE Duration: 5-6 Months... ...appropriate health care services in... ...physician treatment plan. Utilizes clinical skills to assess... ...cost effective, quality care is maintained.... ...junior team members. RN and current unrestricted...Remote workQualityContract workImmediate startMonday to FridayAfternoon shift- ...through integrated delivery of care across the continuum.... ...overarching strategy to provide quality and cost-effective member care... ...care model. Adheres to utilization management (UM) policies and procedures... ...experience. Registered Nurse (RN). License must be active and...Remote jobQuality
- ...YEAR COMMITMENT**JOB TITLE: UTILIZATION REVIEW/CASE MANAGEMENT – NurseDEPARTMENT: CASE MANAGEMENT (QUALITY)HOURS & SHIFT REQUIREMENTS: Full... ...combination of in person and remote considered)GENERAL SUMMARYThe... ...ensures safe transitions of care.GIBSON AREA HOSPITAL & HEALTH...Remote workQualityFull timeSecond jobWork at officeRelocation packageShift work
$39.83 - $59.74 per hour
...Create Impact. Empathy and care are at the heart of North’s... ...bias. About This Position The Utilization Management RN, under the supervision of the... ...and support the delivery of quality customer care as efficiently... ...Call Requirement: None Remote or On-site: Hybrid Remote- Must...Remote workQualityFull timeContract workLive inShift workWeekend work$75k - $100k
Description Our Utilization Management RN (Registered Nurse) evaluates efficiency... ...Location We are open to remote work in the following approved... ...facilitate appropriate and quality services in a cost-effective... ...objectives of quality care and reasonable cost. Would...Remote workQualityFor contractorsWork at officeLocal areaImmediate start- ...the first week. The role is remote but requires regular onsite... ...patients as stated in system utilization management plan. Oversees Clinical Review... ..., including critical care, for appropriateness of admission... ...admission orders, and reporting quality issues. Reviews concurrently...Remote workQualityReliefWeekend work3 days per week
$39.83 - $59.74 per hour
...Utilization Management RN Robbinsdale, MN Posting Date: Jul 10 2026... ...Create Impact. Empathy and care are at the heart of North's... ...and support the delivery of quality customer care as efficiently... ...Call Requirement: None Remote or On-site: Hybrid Remote- Must...Remote workQualityFull timeContract workPart timeFor contractorsFor subcontractorLive inWork at officeShift workWeekend work- ...ensuring that patients receive high-quality care while efficiently utilizing medical resources. Reviews patient... ...Certifications: Registered Nurse (RN) licensure in the state of practice... ...communication variances to the on-site care management teams when appropriate. Reviews and...Remote jobQualityPart timeWork experience placement
$85.7k - $128.54k
...mold in conventional health care, committed to serving seniors... ...for growth and innovation. Utilization Management Nurse Lead Responsibilities... ...Participates in department quality audits and vendor audits to... ...valid, and unrestricted LVN or RN license in California (Non-Compact...Remote jobQualityImmediate start$51.43 - $79.84 per hour
Overview Description - This is a remote role. You MUST live in the... ...Washington (WA) to be considered. Care Manager RN, Per diem / On call, Day shift. The Utilization Review (UR) Nurse has a strong... ...communities by expanding access to quality health care for all. Providence...Remote workQualityDaily paidLive inShift workDay shift- ...and monitoring the utilization of behavioral... ...closely with Case Management to address member... ...benefits, and efficient care delivery processes... ...refers potential quality of care and utilization... ...and active NYS RN license required.... ...opportunity for remote work within all jobs...Remote workQualityContract workWork at office
- ...Utilization Management Registered Nurse (UM RN) We're seeking a dedicated and detail-oriented... ...supporting transitions of care and ensuring patients receive... ..., timely, and high-quality services. The ideal candidate... ...). This is a fully remote opportunity requiring discipline...Remote workQuality
- Cloverhealth is seeking a Registered Nurse (RN) Medicare Quality Assurance Reviewer to support their Utilization Management team. The role involves providing clinical expertise... ...position offers a competitive salary with remote work flexibility and numerous employee...Remote jobQuality
$54.38 - $73.41 per hour
ENL Utilization Management Compensation range: $54.38 - $73.41 Your rate of pay... ...on hiring the right team to care for our patients and their families... ...team. **This position is remote.** POSITION SUMMARY: The... ...medical communication, and quality assessment, and works in conjunction...Remote workQualityDaily paidWork at officeImmediate startFlexible hoursShift work$40 per hour
...Job Title: Utilization Management LPN Allmed Benefits: Vision Insurance, Health... ...agreements, productivity goals, and quality standards in a fast-paced... ..., and continuity of care Meet established productivity... ...to work independently in a remote environment Additional Information...Remote workQualityWeekly payContract workCasual workMonday to Friday
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Utilization Management RN - Quality Care. Be the first to apply!


