Remote Utilization Review Nurse — Medical Management
Bhhc
- Remote job
BHHC is seeking an Utilization Review Nurse in Omaha, Nebraska. This full-time, permanent role strengthens our Medical Management team, leveraging nursing expertise in an office setting with opportunities to learn in a growing industry. No UR experience required; prior critical care or inpatient experience is valued to assess treatment requests and ensure guideline-based care for injured workers. #J-18808-Ljbffr Bhhc
$78k - $88k
...Summary We are seeking a skilled Utilization Review Nurse to conduct prior authorization, prospective... ..., and retrospective reviews for medical necessity and appropriateness of services... ...findings and rationale in medical management systems. Assist in training new nurses...Remote workFull timeContract workWork at officeWork from homeFlexible hours$40 per hour
...in TX Full time remote Candidates must be... ...in the insurance or managed care industry using medically accepted criteria to... ...initial, concurrent review activities; discharge... ...regarding utilization management requirements... ...facilities. Registered Nurse (RN) with valid, current...Remote workFull timeContract workWork at office$35 - $43 per hour
...- $43.00/hr Job Title Clinical Review Nurse – Concurrent Review Location: Remote (California only – must reside... ...Concurrent Review will perform utilization management functions to ensure members receive... ..., concurrent reviews, and medical necessity determinations in alignment...Remote work$20 - $31 per hour
...the nation’s leading specialty risk manager for self-insured organizations,... ...The primary responsibility of the utilization review nurse is to review medical records to determine the medical necessity... ...applicants with arrest or conviction records. #LI-AJ1 #LI-Remote...Remote workHourly payTemporary workWork experience placementLocal areaMonday to Friday- The Elevance Health Companies, Inc. is seeking a Medical Management Clinician to review clinical information and assess medical necessity under guidelines. This role focuses on moderately complex cases and may collaborate with healthcare providers and senior staff. The...Remote jobFull timeMonday to FridayShift work
- ...Overview Title: Clinical Review Nurse – Prior Authorization Review Location: Fully Remote (PST Time Zone - WA/OR... ...Authorization Review to join our Utilization Management team. In this role, you will... ..., and collaborate with medical directors, providers, and care...Remote workContract work
- ...Summary: This position has a remote option for those living... ...as needed. The Utilization Review Nurse is responsible for determining... ...effectively and efficiently manage a diverse workload in a fast... ...for the service and if it is medically necessary. Promote...Remote workFull time
$41 - $45.5 per hour
...Direct Government Clients Role: Nurse Case Management Senior Analyst Location: Remote (within plan states: IL, TX, NM,... ...assessments, health education, and utilization management. Key Responsibilities... ..., concurrent, and retrospective reviews for inpatient, rehab, referrals,...Remote work- ...delegation assessments and annual onsite/remote audits of delegated vendors, medical groups, IPAs, and subcontractors... .... Monitor delegate performance, review compliance reports, and ensure... ...on clinical, behavioral health, utilization management, quality improvement, and...Remote workContract workFor subcontractorWork at officeMonday to FridayNight shift
- ...older adults with complex medical needs. We have four adult day... ...sites. Job Title: Utilization Review Nurse Job Summary The Utilization... ...with hospital UR/Case Management, facility and community providers... ...Work Conditions ~ Remote role with reliable high-speed...Remote workFull timePart timeWork at officeLocal areaWeekend workAfternoon shift
$30.64 - $45.8 per hour
...The Utilization Review Nurse gathers demographic and clinical information on prospective... ...treatment, certifies the medical necessity and assigns an appropriate... ...the goals of the Case Management department and of CorVel. This is a remote position. ESSENTIAL FUNCTIONS...Remote workHourly payMinimum wageFull timeWork at officeLocal areaFlexible hours- SSM Health seeks an Utilization Management Nurse to evaluate medical necessity of hospital admissions and surgical procedures, ensuring payors receive required clinical information and obtaining proper authorization. You will document outcomes in the EHR and collaborate...Remote job
$35 - $45 per hour
...from IntePros IntePros is seeking a Remote Utilization Review Nurse serves as a key clinical liaison,... ...communication with payer plan case managers, patients, and provider teams. Prepare... ...Chapter 7, Milliman Care Guidelines, and medical necessity requirements. Provide...Remote workContract workWeekend work- ...provider in Omaha, Nebraska is seeking a full-time Utilization Review Nurse to ensure effective management of injured workers' treatments. This role does not... ...into a new area. Responsibilities include reviewing medical treatment requests, advocating for injured workers,...Remote workFull timeWork at officeWork from home
- ...Registered Nurse - Utilization Review (Nursing) Location: Aurora, CO. Location: Colorado Military Health... ...: Registered Nurse – Utilization Management. Current POP ends 11/30/25. TO POP ends... ...Nursing, Ambulatory Care Nursing, Medical‑Surgical Nursing or Nursing Case Management...Remote workContract workWork from homeMonday to FridayNight shift
$153k - $177.1k
...complex and/or escalated reviews, and providing... ...appropriate services based on medical necessity. Essential... ...to others and to managers. Pursues self-development... ..., interpretation, and utilization of member health care... ...Medical Terminology Nursing Principles Acts with...Full timeTemporary workWork experience placementLocal areaWork from homeFlexible hoursShift work- ...Brighton Health Plan Solutions, LLC is seeking an Utilization Management Nurse to perform medical necessity reviews remotely. Licensed LPN with strong MS Office skills will review clinical criteria, coordinate with care partners, and document determinations in compliance...Remote work
- ...a Friend Back Remote Work from Home Share... ...MD 21076 Category: Nursing Schedule: Day Shift... ...Plans (JHHP) is the managed care and health... ...AM - 5:00 PM As a Utilization Review Registered Nurse for Johns... ...Evaluate member benefits and medical criteria to determine...Remote workFull timeLocal areaWork from homeMonday to FridayDay shift
$85.99k - $105.34k
A community-focused healthcare organization in Oregon is seeking a Utilization Review Nurse for a full-time remote position. The role involves evaluating clinical service requests, conducting prior authorization reviews, and collaborating with interdisciplinary teams. Applicants...Remote workFull time- A healthcare provider is seeking a Utilization Review Nurse to coordinate resources and ensure efficient delivery of home health care. This role... ...and substantial experience in utilization review or case management. Strong communication skills and flexibility are essential...Remote workContract work
- ...insurance group in Omaha seeks a full-time Utilization Review Nurse to oversee treatment requests and... ...critical care. The role involves reviewing medical requests, advocating for injured... ...documentation. The position offers options for remote work, health insurance, and other...Remote workFull time
$1,600 - $1,800 per week
...NOW HIRING: Registered Nurse - Utilization Management Location: Buckley AFB & Peterson... ...no holidays, no telehealth/remote work Minimum... ...Utilization Management, Utilization Review, or Case Management ~•... ..., Case Management, or Medical-Surgical (ANCC or NCQA)...Remote workContract workImmediate startMonday to Friday- ...For We have openings in our Omaha, Nebraska office for Utilization Review Nurses. The Utilization Review Nurse ensures all aspects of an... ...requirements. This is a full-time, permanent position within our Medical Management team that allows experienced nurses to put their years...Permanent employmentFull timeWork at officeWork from home2 days per week
- ...Blue Shield of Kansas City is looking for a Clinical Review Nurse to utilize clinical expertise in managing healthcare services efficiently. Candidates must... ...utilization management reviews and ensuring compliance with medical guidelines while effectively communicating with...Remote work
$30 - $34 per hour
...Overview Utilization Review Nurse - Remote at Astrana Health Location: 600 City Parkway West 10th... ...judgement to approve or deny outpatient medical services for patients based on... ...outpatient UM. Candidates with only case management experience are not a fit....Remote workHourly payMonday to Friday- ...opportunity for a local remote position. Schedule... ...: ~2 years of staff nurse experience performing... ...patients. ~2 years of utilization review (UR) experience... ...hospital admissions for medical necessity. ~ Must live... ...resources to help you manage your physical, emotional...Remote workReliefLocal areaWork from homeMonday to FridayFlexible hoursShift work
- ...From preventative care to managing chronic conditions, we’re dedicated... ...Health. Position Title Utilization Review Nurse Department Umpqua Health... ...Pacific Standard Time) Location Remote position Salary Wage Band 2... ...service requests to ensure medically necessary, cost-effective,...Remote workFull timeWork at officeLocal areaMonday to FridayFlexible hours
$1,966 per week
...first 25 applicants Nurses – are you looking... ...in personalized managed health care, focused... ..., including medical, dental, vision, long... ...Work-life balance. Remote/hybrid setting (once... ...individual will utilize clinical knowledge... ...to a second level reviewer. This individual interfaces...Remote workFull timeTemporary workPart timeWork at officeWork from homeMonday to FridayFlexible hours- ...applicants This is full-time remote, but candidates must... ...working in the insurance or managed care industry using medically accepted criteria to... ...accurate and timely medical review of claims suspended for... ...prioritization skills. ~ Registered Nurse (RN) with unrestricted...Remote workFull timeContract work
$78k - $88k
...Gainwell Technologies is seeking a skilled Utilization Review Nurse to perform prior authorization across prospective, concurrent, and retrospective reviews for medical necessity, documenting findings and ensuring policy compliance. This home-based role supports providers...Remote work
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