UM Review Nurse
KZX - Astrana Health Management, Inc.
Utilization Review Nurse
Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services Department. In this position, you will utilize your clinical judgement to approve or deny outpatient medical services for patients based on Medical Necessity Criteria, respective to various Health Plans. This is a remote position for CA-licensed nurses. Candidates must live in California.
We are seeking nurses with at least one year of outpatient Utilization Management experience in a fast-paced setting.
Our Values:
- Put Patients First
- Empower Entrepreneurial Provider and Care Teams
- Operate with Integrity & Excellence
- Be Innovative
- Work As One Team
$70k - $120k
...also offer paid holidays, birthday off, and unlimited PTO as well as a 401k plan. Job purpose The position of UM Outpatient Review Nurse reports to the Director, Case Management. The position of UM Outpatient Review Nurse is part of the Case Management team...SuggestedFull timeWork at officeRemote workFlexible hoursWeekend work- ...Are you a bedside nurse seeking a change from the hospital setting? If you answered "yes", Alliant... ...place for you! Alliant is recruiting a Hybrid Review Nurse for its Prior Authorization and Utilization Management (PA/UM) team. The Review Nurse conducts prior approval...SuggestedContract work
- ...Job Summary: As an on-site Hospital Utilization Management (UM) Nurse, you are the primary link between the clinical floor and administrative... ...for performing admission and concurrent medical record reviews to ensure patients are in the correct Patient Class (e.g., Inpatient...SuggestedFull timeImmediate startRemote workShift work
$77.91k - $116.86k
...saving them. Together.Alignment Health is seeking an inpatient review nurse to join the remote utilization management team. As an inpatient... ...documents, and reports pertinent clinical criteria as established per UM policy and procedure. 12. Monitors for any over utilization...SuggestedFull timeImmediate startRemote workMonday to Friday$45 per hour
...Job Description Job Description Utilization Management Nurse Coordinator (RN or LVN) needed for a temp 6+ month,... ...effective healthcare in a fully remote managed care setting. The UM RN Nurse Coordinator reviews outpatient authorization requests, assesses medical...SuggestedContract workTemporary workRemote workMonday to FridayWeekend work- ...Start date: ASAPFloating expectation: NoRatios: 1:40Years of experience required: 3-year acute medical care manager/UM experience performing utilization review in a hospital setting (not health plan/medical group)First-timers accepted: Seasoned traveler is requiredHardstop...Shift workWeekend work
$45 - $51 per hour
...Utilization Management experienceRecent hospital-based Utilization Review experience requiredEpic experience required , with recent use... ...appropriate level of careImportant: Health plan or medical group UM experience alone does not meet the requirement. Candidates need acute...Hourly payWeekend work- ...date: ASAP • Floating Expectation: No • Ratios: 1:40 • Years of experience REQ: 3-year acute medical Care Manager/UM experience performing utilization review in a hospital setting (not health plan/medical group) • First-timers accepted: Seasoned traveler is required...Immediate startShift workWeekend work
$54.1k - $116.77k
...s making a difference in the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review, you’ll play a vital role in ensuring members receive timely, medically necessary care through thoughtful clinical...Hourly payFull timeTemporary workLocal areaRemote workMonday to FridayFlexible hoursShift work$65k - $75k
...meaningful, measurable impact. Job Description The Clinical Review Nurse makes prospective medical necessity determinations on prior... ...Identifies and refers potential quality-of-care concerns to UM Leadership. Participates in the HealthHelp Quality Management...Hourly payFull timeWork at officeLocal areaRemote workMonday to Friday$69.8k - $125.9k
...responsible for ensuring compliance with Utilization Management (UM) and Quality Review (QR) functions performed by the health plan. The role... ...clinical review activities requiring 5+ years of experience as a Nurse Reviewer or Clinical Reviewer. Responsibilities include...Full timeRemote workNight shift$33.5 - $45 per hour
...1-2 years of inpatient and SNF Concurrent review and discharge planning experience. To provide... ..., and BH. The case manager is a licensed nurse (RN or LVN). A care manager can be a... ...restrictive environment To follow the UM/QI/CM/SNP/CMC program descriptions Assigned...Hourly pay- ...Description Summary: The RN Navigator Home Health Review plays a crucial role in monitoring post-acute patients to ensure they continue... ...outreach to post-acute facilities to review patient needs. The Nurse makes recommendations to primary care providers regarding...Full timeWork at officeMonday to Friday
- ...Requires Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing and 2 - 4... ...Performs medical necessity and clinical reviews of authorization requests to determine... ...a positive and inclusive workplace. UM is highly focused on how we can be better...Remote workFlexible hours
$40 - $43 per hour
...Job Description Job Description Title: Clinical Review Nurse - Concurrent Review Location: Remote - Kentucky Pay: $40–$43 per... ...professional experience. ~ Previous utilization management (UM) experience is required. ~ Relevant clinical review experience...Hourly payTemporary workRemote workMonday to FridayShift work$78k - $88k
...career in a company that values work-life balance, continuous learning, and career development. Summary We are seeking a Nurse Reviewer (RN) who will be responsible for performing clinical reviews to determine whether medical record documentation supports the need...Full timeRemote workMonday to FridayFlexible hours- ...Position Title Clinical Review Nurse - Prior Authorization Work Location Remote - PST and CST (No CA and NY candidates please) Assignment... ...quality and cost effectiveness of medical care. Background & Context UM is highly focused on how we can be better partners to our...Remote workFlexible hoursShift work
- ...Health System is seeking an experienced Utilization Management RN Reviewer to work remotely with a focus on admission, concurrent and... ...candidates are RNs with strong clinical judgment, knowledge of UM criteria, and proficiency with Microsoft Office. #J-18808-LjbffrWork at officeRemote work
$71.1k - $97.8k
...The Hong Kong Study Skills Research Institute is seeking a Pre-Authorization Registered Nurse to join their team. This role involves reviewing prior authorization requests to ensure appropriate care while working from home. Ideal candidates will be licensed RNs with a...Remote workWork from home- ...Leader is responsible for oversight of staff UM RNs to ensure coordination and function of... ....It is expected that all RN Clinical Nurses are licensed, knowledgeable and uphold the... ...& Financial Complianceo Medical Necessity Reviews: Use criteria like InterQual or MCG to perform...Full timeImmediate startRemote workShift work
$50k - $60k
...development. Summary Gainwell Technologies is seeking a Medical Reviewer (Laboratory Specialist) to provide laboratory subject-matter... .... Work independently while collaborating with physicians, nurses, other clinical specialists, operations teams, providers, and...Full timeRemote workHome officeMonday to FridayFlexible hours$61k - $68k
...Scope: The Medical Review Specialist is a Registered Nurse who conducts the Utilization Review process by obtaining medical information and confirming the medical necessity of hospital admissions and/or outpatient procedures. The Medical Review Specialist will perform...Full timeContract workHome office$53 per hour
...OPPORTUNITY – GRIEVANCE & APPEALS / UTILIZATION REVIEW $53/hour | 100% Remote | Long-Term... ...We're hiring experienced Registered Nurses to join a leading healthcare organization... ...Active NY RN license Direct outpatient UM experience. Strong outpatient Utilization...Remote jobLong term contractWork from homeMonday to FridayShift workWeekday work- ...Description Job Description Clinical Reviewer *This is a part-time role, 3 days per week... .... Job Summary: The Utilization Review Nurse is responsible for reviewing and interpreting... ...of Utilization Review/Management (UR/UM) and/or Prior Authorization experience....Contract workPart timeWork at officeShift work3 days per week
- ...profile if interested. Title: Clinical Care Reviewer Location: Doral, FL Duration: 3 months Job... ...Current FL RN licensure Registered Nurse graduated from an accredited Diploma, Associates... ...and Procedures, as defined by specific UM role (Prior Authorization, Concurrent Review...
- ...Collaborating with the Medical Director, the full-time Registered Nurse Utilization Review will manage care variance reduction, ensure timely discharges, and refer members to appropriate resources while working remotely. Key responsibilities Assist in building and implementing...Full timeRemote work
$61.05k - $98.33k
...Itemization Review NurseThe Itemization Review Nurse provides a summary and analysis of items by reviewing all charges on a UBIB submitted by a medical facility to determine accuracy of billed charges. This is a remote position.Essential Functions & Responsibilities:Collects...Full timeWork at officeRemote workFlexible hours- ...Community Health Network (CHN) has been placing experienced nurses and therapists in home care, hospice, and case management for over... ...with a need for an experienced RN Case Manager with Utilization Review/UM experience. This position is remote based and requires an...Contract workRemote workMonday to FridayFlexible hours
- ...emotional needs, and support systems.Conducts initial and concurrent reviews of clinical documentation for medical necessity and appropriate... ...experience required.EducationBachelor's degree or higher in Nursing required upon hireLicensure/Certification/RegistrationRN -...
- ...team-focused work environmentWhat You Will DoConduct clinical reviews of patient records to evaluate medical necessity, appropriateness... ...reimbursement and complianceCollaborate with physicians, nursing staff, and interdisciplinary teams to ensure appropriate resource...Full timePart timeWork at officeLocal areaRemote workShift workDay shift
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