Remote RN: Clinical Utilization Reviewer (Alabama)
Comagine Health
- Remote job
Comagine Health is seeking Clinical Utilization Review Nurses (RN) based in Alabama to assess medical necessity and quality of care through prospective, concurrent, and retrospective utilization management reviews. This full-time, remote position supports compliant, cost-effective care in line with Alabama contractual requirements. Active RN license in Alabama and 3+ years direct patient care are required. You will apply Medicaid criteria, coordinate with Physician Advisor, and collaborate with #J-18808-Ljbffr Comagine Health
- ...Clinical Utilization Review Nurses (RN) Based In Alabama Comagine Health is a national, mission-driven, nonprofit organization that has engaged in health care... ...care delivery and patient outcomes. Our talented remote workforce spans the country and plays a vital role...Remote workFull timeContract work
$45 - $50 per hour
...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... ...nursing programs with an active New York RN license. #J-18808-Ljbffr...Remote jobHourly pay- Comagine Health is seeking Clinical Utilization Review Nurses (RN) based in Alabama to assess medical necessity and quality of care through prospective, concurrent, and retrospective reviews. This full-time remote role supports compliant, cost-effective care under Alabama...Remote jobFull timeContract work
- ...subsidiary, seeks a Medical Reviewer II (RN) to perform medical claim reviews... ...decisions and supports utilization review across multiple services. The position is remote, full-time, with standard hours... ...associate degree, and 2+ years of clinical RN experience required. #J-1...Remote jobFull time
$32 - $33 per hour
...opportunity is for you. We have an opening for a Clinical Field Reviewer - Remote in Eastern MT We are a team of Registered Nurses... ...coordination, practice cultural humility with each client, and utilize evidence-based practice as a foundation for our...Remote workHourly payPart timeLocal areaWork from homeHome officeFlexible hours- 1 week ago Be among the first 25 applicants Job Title:Clinical Review Nurse (RN) - Utilization Management Location:Oregon or bordering states Duration:... ...Future Opportunities) Clinical Program Coordinator RN *Remote* Clinical Program Coordinator RN *Remote* Medford, OR $...Remote workContract work
$88k - $93k
Profile Remote work opportunities are available in the following states: AK, AR... ...encouraged to apply. Job Summary The Utilization Management Clinical Review nurse reviews and makes decisions... ...Experience Required: Active, unrestricted RN license U.S. Citizen Ability to...Remote workContract workTemporary workInterim roleWork at officeLocal areaShift work- ...CVS Health is seeking an experienced Utilization Management Nurse Consultant for a 100% work-from-home... ...and benefit coordination, requiring an active RN license and hospital experience. Responsibilities include reviewing medical necessity, coordinating with providers...Remote workWork from home
$85k - $92k
...TEEMA Solutions Group is seeking a Clinical Quality Reviewer to support a federal healthcare program. This... .... Candidates must have a valid RN or LCSW license with at least three years... ...clinical experience. The position may be remote or onsite based on business requirements...Remote workWork at officeHome office$70k - $120k
...Fully Remote : Clinical Documentation Specialist Job Description... ...concurrent and retrospective reviews of medical records to ensure... ...complete clinical documentation. Utilize clinical knowledge and expertise... ...Qualifications Registered Nurse (RN) with a current license from...Remote workLocal areaMonday to Friday$50k
...Department Overview The Clinical Documentation Specialist will... ...concurrent and retrospective review of provider documentation, query... ...of patient records in a remote setting. The Registered Nurse... ...physicians and nursing as needed. Utilizes software systems (including...Remote workFull timePart time- ...Utilization Manager Registered Nurse (UMRN)Spectrum Healthcare Resources... ...). These will be completely remote positions, working entirely... ...Nurse's home. The Nurse will be reviewing cases, educating patients on... ...the HCWs must have pertinent clinical experience within the past...Remote workFull timeContract workWork at officeWork from homeMonday to Friday
- ...RN / Medical Reviewer / Remote Job Details Professional Discipline : Registered Nurse Specialty : Utilization Review Employment Type : Full Time City :... ...eligibility regarding benefits and clinical criteria and assess and monitor...Remote workFull timeContract workLocal areaShift work
- Spectrum Healthcare Resources seeks a Utilization Manager Registered Nurse (UMRN) to work entirely from home in a fully remote role. The nurse will review cases, educate patients on... ...schedule of 8 hours per day, requiring an RN with a Bachelor's degree, state licensure...Remote jobWork from homeMonday to Friday
- ...seeking a Registered Nurse for a temporary Utilization Management role. You will ensure prior... ...care programs. Required are an active CA RN license and at least five years in patient... ...substitute for experience. Hybrid work and remote- interview options are offered. #J-18808-...Remote workTemporary work
- ...seeking an experienced Utilization Management Nurse 2 to support... ...medical necessity reviews, care coordination, and... ...members. You will use clinical judgment to decide on level... ...members. The role is remote/work-from-home with... ...annually; requires Kentucky RN license, 2+ years...Remote jobWork at officeWork from homeShift work
- ...CVS Health is seeking a Utilization Management (UM) Nurse Consultant for a fully remote, full-time role open to CST zone candidates. You will coordinate, document... ...and turnaround times. Responsibilities include reviewing medical necessity, collaborating with providers,...Remote workFull time
- ...organization is seeking a Care Manager RN for a remote role primarily serving the state of... ...This per diem position involves crucial utilization management activities, ensuring compliance... ...RN license along with 3 years of clinical experience. The role offers competitive...Remote workHourly payDaily paidDay shift
$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... ...an active RN license and 3+ years of Managed Care or Clinical experience. The successful candidate will work...Remote workWeekend work- A healthcare staffing agency is seeking a Utilization Management RN to work remotely from PA, DE, or NJ. The role involves assessing clinical information, determining medical necessity for services, and collaborating with providers. Candidates should have at least three...Remote workFlexible hoursWeekend workDay shift
$2,213 per month
...Job Description Job Description RN - Utilization Review - Travel Gross Pay (weekly): $2213.0 Taxable Pay (weekly): 680.0 Non-taxable Pay (weekly): 1533.0 Shift: Type - 8hr Days, Schedule - No schedule available Location: Fort Myers, FL Scheduled Hours...Remote jobWeekly payShift work- ...delivering care supported by technology to help millions live healthier lives. The Clinical Appeals RN defends MassHealth prior authorization decisions and conducts pre-service reviews, working with managers and peers. Based in Massachusetts with telecommute options for...Remote job
- UnitedHealth Group seeks an experienced SSBV Clinical Claims Review RN to perform administrative reviews of short stay inpatient hospital claims. The role requires documenting determinations and maintaining screening criteria, contributing to efficient, compliant health...Remote job
$30 - $38 per hour
A healthcare organization is seeking a part-time Utilization Review Nurse RN to conduct assessments and reviews for medical necessity of treatment... ...must have a current RN license and at least 1 year of clinical experience. Competitive hourly compensation worth $30-$38...Remote workHourly payPart time- ...RN Utilization Review Review patient medical records to assess the appropriateness and medical... ...and payers to ensure compliance with clinical guidelines, regulatory requirements, and... ...hospital-based) ~ Skilled experience with remote work Length of assignment: 13...Remote workShift workWeekend work
- ...WNS, part of Capgemini, is seeking a remote RN/LPN for utilization review in the United States. The role involves assessing medical necessity, resolving escalations, and maintaining HIPAA-compliant documentation with HealthHelp policies. Requires active nursing license...Remote workWork at office
- ...TurningPoint Healthcare Solutions is hiring a Utilization Review Nurse to work remotely. The ideal candidate must hold a valid LPN or RN license and possess strong critical thinking and clinical expertise. Responsibilities include performing initial clinical reviews,...Remote work
$70k - $75k
...analytics, Guidehealth leverages remotely-embedded Healthguides™ and a... ...Job Description The Utilization Management Registered Nurseis... ...responsible for performing utilization review activities in compliance with... ..., and accurately document clinical information from medical...Remote workBi-weekly payFull timeTemporary workFor contractorsLocal areaWork from home$38.46 - $43.27 per hour
...Clinical Reviewer As the Clinical Reviewer, you will be responsible for... ...to: Performing case reviews utilizing regulatory guidelines criteria... ...NY office. Ability to work remotely one day per week after... ...Nurse, required (open to any RN state license). Graduate...Remote workHourly payFull timeFor contractorsWork at office1 day per week- Concierge Home Care is seeking an experienced Utilization Review Specialist (RN) to join our remote home health team. This role emphasizes OASIS review, coding accuracy, QA, and remote documentation audits. The ideal candidate holds an active Florida RN license, OASIS certification...Remote job
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