Clinical Utilization Management Reviewer - Remote
Excellus BlueCross BlueShield
Excellus BCBS is seeking qualified candidates for a position overseeing the coordination of behavioral health services. The role requires a NYS RN license and 3+ years of clinical experience. Responsibilities include clinical reviews and collaboration with providers to ensure quality care delivery. Preferred candidates will have utilization management experience and strong communication skills. Competitive salary offered based on experience, and potential for remote work. #J-18808-Ljbffr
- ...Role Overview Our Utilization Management Reviewers evaluate medical necessity for inpatient and outpatient... ..., ensuring treatment aligns with clinical guidelines, regulatory requirements,... ...Flexible work solutions include remote options, hybrid work schedules, competitive...Remote workMonday to FridayFlexible hoursWeekend 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 board... ...with management and providing guidance on clinical questions. This is a unique opportunity to work...Remote workFull timeWork from home
$174.07k - $374.92k
...Company: Oak Street Health Title: Full-Time Utilization Management Physician Reviewer Location: Remote/ Treehouse Role Description: This full-... ...by applying utilization management (UM) criteria, clinical judgment, and internal policies and procedures....Remote workHourly payFull timeLocal area- ...A healthcare management organization is seeking experienced Physician Reviewers to join their Medicare Utilization Management team in a remote position. Responsibilities include reviewing clinical service requests, applying evidence-based guidelines, and collaborating...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
- ...Street Health is seeking a Full-Time Utilization Management Physician Reviewer to ensure accurate coverage... ...utilization management decisions based on clinical judgment. Candidates must have a... ...practice in the US. This position offers remote work options and competitive...Remote workFull time
- ...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
- ...Excellus BCBS is hiring for a Utilization Management position based in Albany,... ...ideal candidate will have clinical experience, strong communication... ...pre-service clinical reviews and collaborating with healthcare... ...range and potential for remote work based on departmental...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
- ...IDD Utilization Management Reviewer Competitive Compensation & Benefits Package! Position eligible for: ~ Annual incentive bonus plan... ...Forgiveness Qualifying Employer Office Location: Remote Option Available; Flexible for any of Partners' NC locations...Remote workWork at officeFlexible hours
$90.87 - $154.33 per hour
A leading healthcare management company is seeking a Physician Clinical Reviewer specialized in Dermatology. This remote position involves reviewing cases and collaborating with physicians to ensure compliance with medical necessity guidelines. Candidates should possess...Remote work$90.87 - $154.33 per hour
A healthcare management company is seeking a remote Physician Clinical Reviewer specializing in Dermatology. This role involves reviewing cases that require clinical expertise, interacting with physicians, and providing clinical rationale for appeals. Candidates must hold...Remote work- ...Minimum Offer $0.00 Maximum Offer $0.00 Now Hiring: LTC Utilization Management Reviewer Summary: Build your Career. Make a Difference. Presbyterian... ...and grammar. Able to summarize from medical clinical notes, progress notes, needs assessments, functional assessments...Full timeTemporary workLocal areaImmediate startWork from homeShift work
- ...Time (40 hours/wk) Required Degree 2 Year Degree Manage Others No The Utilization Management (UM) Clinical Reviewer is responsible for performing utilization review... ...schedule for this role is Tuesday - Saturday (fully remote) Key Responsibilities: Review and process prior...Remote jobFull timeWork at officeLocal areaWeekend work
$211.2k - $277.2k
...re Oscar. We're hiring a Physician Reviewer to join our Utilization Management team. Oscar is the first health... ...and pharmacy services by reviewing clinical information and applying evidence-based... .... Work Location: This is a remote position, open to candidates who reside...Remote workFull timeLocal areaWork from homeHome officeWeekend work- ...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
- ...Territorial Epidemiologists is looking for a Clinical Review Supervisor to oversee clinical staff conducting utilization reviews. This fully remote position requires strong leadership in... ...and a proactive approach to quality management. Key responsibilities include...Remote work
- ...Epidemiologists is seeking a Clinical Review Supervisor to provide... ...of clinical staff conducting utilization reviews and specialty review activities. This fully remote position requires a strong background... ...This role supports quality management initiatives aimed at...Remote work
- ...Clinical Nurse, Medical Management/Utilization Management Saratoga Medical is hiring for a Clinical Nurse, Medical Management/Utilization Management in Falls Church, Virginia. Package includes competitive rate, paid time off and benefit options. This is a great...Remote workFull time
$110k - $203.51k
...scientists, digital innovators, program and construction managers and other professionals delivering projects that... ...**AECOM** is seeking an **Assistant Project Manager - Utility Design Reviewer** to work **remotely** . However, the client is located in Sacramento, CA and...Remote workFor contractorsFor subcontractorLocal areaWorldwideRelocationVisa sponsorshipFlexible hours- ...Clinical Documentation Integrity (CDI) Second Level Reviewer The Clinical Documentation Integrity (CDI) Second Level Reviewer... ...high-quality documentation by utilizing queries that are effective,... ...independently; demonstrates effective time management and prioritization of tasks....Remote workWork at office
- ...faculty or staff position, please review this tip sheet. The Clinical Documentation Integrity (CDI) Second... ...Facilitates high-quality documentation by utilizing queries that are effective, clear,... ...; demonstrates effective time management and prioritization of tasks. 15....Remote workFull timeTemporary workWork at officeWorldwide
- ...MVP Health Care is seeking a remote Sub-Acute RN UM Reviewer to join its Utilization Management team. In this vital role, you will conduct clinical reviews ensuring compliance with Medicare guidelines and support high-quality patient outcomes. The role requires current...Remote work
$150 - $170 per hour
...CareCentrix is seeking a Part-Time Physician Reviewer to conduct utilization reviews, ensuring medical necessity across various... ...candidate is an MD or DO with at least 3 years of clinical practice and utilization management experience. The position offers flexible hours,...Hourly payPart timeFlexible hoursWeekday work- ...Detroit Wayne Mental Health Authority is seeking a Clinical Specialist to provide utilization management services. This role involves coordinating care across... ...behavioral healthcare. The position offers flexibility with remote work possibilities under supervisory approval. #J-1...Remote job
- ## Reviewer I, MedicalApplyremote type: Hybridlocations: Myrtle... ...criteria sets and/or performs utilization management of professional, inpatient... ...indicated protocol sets or clinical guidelines. Provides... ...Friday. **This position will be remote after 6 months of onsite training...Remote workFull timeContract workFor contractorsWork at officeLocal areaMonday to Friday
- The Council of State and Territorial Epidemiologists is seeking a Clinical Utilization Review Nurse (RN) to conduct utilization management reviews remotely. Candidates must hold a BA/BS in Nursing, possess a current RN license, and have a minimum of 3 years of clinical...Remote jobFull time
- Acentra Health is seeking a Supervisor of Clinical Review to manage Utilization Management activities and ensure high-quality clinical programs. This position requires strong leadership skills and a deep clinical background. Responsibilities include overseeing prior authorization...Remote job
- A leading medical review organization is seeking Board‑Certified physicians in Pediatric Hematology Oncology for flexible, remote Utilization Reviews. This role requires conducting independent... ...license and have at least 5 years of clinical experience. This opportunity is...Remote jobPart timeFlexible hours
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