Senior RN: Care Management & Utilization Review (Remote)
Elevance Health
- Remote job
Elevance Health is seeking an experienced nurse for complex case management and medical necessity determinations. You will collaborate with clinicians, discharge planning teams, and the Medical Director to ensure quality care and appropriate utilization. The role emphasizes nursing judgment, holistic assessment, and cross-functional collaboration, with remote work options and a hybrid attendance model as per Elevance Health policies. #J-18808-Ljbffr Elevance Health
- Centene is seeking a Supervisor of Utilization Management to lead the Prior Authorization, Concurrent Review, and Retrospective Review teams to ensure appropriate care for NICU members. This role... ...compliance. The position offers remote work in Missouri with a full-time...Remote jobSeniorFull timeDay shift
- Applied Underwriters, located in Omaha, NE, is seeking a skilled RN for utilization management roles. The position involves reviewing clinical information, coordinating care, and working closely with various stakeholders. Applicants should have at least 5 years of clinical...Senior
$75.3k - $135.4k
...Corporation is seeking a Clinical Supervisor to oversee the utilization management team ensuring appropriate care for members. The ideal candidate will supervise day-... ...experience in a related field, along with an active RN license in California. This position offers a salary...Remote workSenior- ...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 work
- ...high-quality patient care across skilled nursing... ...some flexibility for remote work based on business... ...community stakeholders to review clinical records,... ...Active, unrestricted RN license in the state... ...experience ~ Experience in utilization management, medical record review...Remote workSeniorWeekend workWeekday work
- Medica is seeking a Remote Utilization Review RN to review and document member case history for approval of coverage. Requires RN or LPN licensure and a Bachelor’s degree or equivalent experience, with 5+ years of post-degree experience. The role involves analyzing trends...Remote jobSenior
- ...FOR A 2 YEAR COMMITMENT**JOB TITLE: UTILIZATION REVIEW/CASE MANAGEMENT – NurseDEPARTMENT: CASE MANAGEMENT (QUALITY... ...Hybrid (combination of in person and remote considered)GENERAL SUMMARYThe... ...disciplinary teams ensures safe transitions of care.GIBSON AREA HOSPITAL & HEALTH...Remote workFull timeSecond jobWork at officeRelocation packageShift work
$30.58 - $55.09 per hour
...professional on our Medical Management/Health Services... ...Purpose Routinely reviews more challenging... ...level of care in accordance with... ...healthcare providers, utilization management team, and... ...and requires NY RN Licensure. Pay Range... ...to work with remote, hybrid, field or...Remote workSeniorHourly payFull timePart timeWork at officeFlexible hours- ...for clinical member services review assessment processes. Responsible... ...integrated delivery of care across the continuum. Contributes... ...care model. Adheres to utilization management (UM) policies and procedures.... ...experience. Registered Nurse (RN). License must be active and...Remote job
$35 - $40 per hour
...offerings for clinical, case management, member engagement,... ...countries. Job title: RN Utilization Management Reviewer Job Description: We... ...to the primary care team, specialty providers,... ...weekends This is a fully remote work at home role. You must...Remote workHourly payTemporary workCurrently hiringMonday to FridayFlexible hoursWeekend work- ...during the first week. The role is remote but requires regular onsite... ...of appropriate clinical review of all applicable patients as stated in system utilization management plan. Oversees Clinical Review... ...patients, including critical care, for appropriateness of admission...Remote workReliefWeekend work3 days per week
$51.43 - $79.84 per hour
Overview Description - This is a remote role. You MUST live in the state of Washington (WA) to be considered. Care Manager RN, Per diem / On call, Day shift. The Utilization Review (UR) Nurse has a strong clinical background blended with knowledge and skills in Utilization...Remote workDaily paidLive inShift workDay shift- ...Kansas City is looking for a Clinical Review Nurse to utilize clinical expertise in managing healthcare services efficiently.... ...have at least 3 years of direct patient care experience and an Associate degree in nursing, along with RN licenses in Missouri and Kansas. This...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... ...requires an active RN license and 3+ years of Managed Care or Clinical experience. The successful candidate...Remote workWeekend work- A leading healthcare organization is seeking a Care Manager RN for a remote role primarily serving the state of Washington. This per diem position involves crucial utilization management activities, ensuring compliance with payer requirements and regulations. Candidates...Remote workHourly payDaily paidDay shift
- ...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 leading medical review company in Washington is seeking a Utilization Management Nurse Reviewer. The role involves assessing medical... ...providers to optimize care. Candidates must have a valid nursing... ...offers a competitive salary range, remote work options, and a...Remote work
$2,210 per week
...in personalized managed health care, focused on what'... ...Work-life balance. Remote/hybrid setting (... ...individual will utilize clinical knowledge... ...to a second level reviewer. This individual... ...is not limited to RN, LMSW, LMHC.... ...80 Yearly Salary Seniority level Seniority level...Remote workFull timeTemporary workPart timeCasual workWork at officeWork from homeAll shiftsMonday to FridayFlexible hours- ...and monitoring the utilization of behavioral health... ...Director for review and works closely with Case Management to address member needs... ...benefits, and efficient care delivery processes.... ...and active NYS RN license required. Bachelors... ...be opportunity for remote work within all...Remote workContract workWork at office
$1,600 - $1,800 per week
...Hiring: Registered Nurse – Utilization Management Location: Buckley... ..., no telehealth/remote work Minimum Qualifications... ..., and unrestricted RN license... ...experience in direct patient care • 12 consecutive months... ...Management, Utilization Review, or Case Management...Remote workContract workImmediate startMonday to Friday- ...Refer a Friend Back Remote Work from Home Share This... ...Health Plans (JHHP) is the managed care and health services business... ...8:00 AM - 5:00 PM As a Utilization Review Registered Nurse for Johns... ...Unencumbered Registered Nurse (RN) license in Maryland (or...Remote workFull timeLocal areaWork from homeMonday to FridayDay shift
$77.96k - $120.37k
Santa Barbara Cottage Hospital is seeking a Utilization Review Supervisor RN to direct operations within the department. This remote role requires a leader adept in managing a team, ensuring service quality, and handling human resources matters. The ideal candidate will...Remote job- ...Health Plan Solutions seeks an experienced Utilization Management Nurse (LPN) to perform medical necessity and benefit reviews remotely. You will work within UM processes, coordinate... ...Office, and 2+ years in UM within managed care. Prior experience in various reviews and...Remote jobWork at office
- ...being of people through patient care, research and education.... ...delivery of such care; achieved via managing the cost of care while... ...Functions Applies approved utilization criteria to monitor... ...levels of care and continued stay review. Communication to third-party...Remote workWork at officeShift workNight shiftRotating shift
- CorVel Corporation is looking for a Utilization Review Supervisor RN to direct operations in Rancho Cucamonga. The role includes managing day-to-day operations, ensuring quality service, and handling HR matters. This remote position requires strong communication skills,...Remote job
$70k - $75k
Guidehealth seeks an experienced Utilization Management Registered Nurse to perform UR activities and document cases per federal, state,... ...directors and providers while ensuring timely, compliant reviews. Remote work option; salary range $70,000-$75,000 annually. Benefits...Remote job- 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 job
- ...their Prior Authorization team within the Medical Management/Health Services department. The role ensures quality care for members by supervising daily activities and... ...years of related experience, and have an active RN license. Benefits include competitive pay, health...Remote jobSeniorFlexible hours
- Guidehealth is seeking a Utilization Management Registered Nurse (RN) for a fully remote, full-time position. The role involves applying medical necessity criteria to reviews, documenting findings, and interfacing with providers and members to ensure timely, compliant determinations...Remote jobFull time
- UnitedHealth Group is seeking a Senior Care Advocate within Utilization Management to support Medi-Cal and... ...funded medical necessity reviews across diverse provider... .... The position offers remote work within the U.S. and... ...with a Master’s degree or RN in behavioral health, plus...Remote jobSenior
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