Remote Utilization Management Nurse (RN)
Cambia Health Solutions
Cambia Health Solutions, Inc. is seeking a Utilization Management Nurse to join our Clinical Services team. This remote role supports members in Oregon, Washington, Idaho or Utah, conducting prospective, concurrent and retrospective reviews to ensure medical necessity and promote cost-effective care. The candidate will collaborate across disciplines, maintain documentation, and respond to inquiries while upholding privacy and compliance standards. #J-18808-Ljbffr
$60.2k - $107.4k
...Optum is a global health services company focused on improving health outcomes through innovative care and technology. The Utilization Management Nurse will review patient records and craft defensible appeal letters per guidelines while adhering to HIPAA and company...Remote workFull timeMonday to Friday$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 and requires an active RN license and 3+ years of Managed Care or Clinical experience. The successful candidate...Remote workWeekend work- ...UnitedHealth Group's Optum unit seeks a Utilization Management Nurse to review medical records and craft defensible appeal letters with attention... ...anywhere in the U.S. and a competitive benefits package. Requires RN license, associate degree, and 3+ years bedside nursing in...Remote workMonday to Friday
$70k - $75k
...Utilization Management Registered Nurse (RN) - Remote The Utilization Management Registered Nurse is responsible for performing utilization review activities in compliance with federal and state regulations, URAC standards, and Guidehealth policies. This role applies...Remote workBi-weekly payFull timeTemporary workFor contractorsLocal areaWork from home- ...CVS Health is seeking an experienced Utilization Management (UM) Nurse Consultant to join our remote team. This 100% work-from-home role serves members across the CST zone, ensuring safe, appropriate care and timely approvals. You will review clinical documents, collaborate...Remote workWork from home
- ...UTILIZATION MANAGEMENT RN There’s no place like Liberty Health Come explore career opportunities... ...REQUIREMENTS: ~ Licensed Registered Nurse credentialed from an accredited school... ...Clearly communicates instructions to remote users. Visit for more...Remote workWork at office
- ...Humana is seeking a skilled Utilization Management Registered Nurse to interpret and coordinate medical services and benefit determinations for post-acute... ...in the right setting. The role requires a compact RN license, 1+ year of clinical RN experience, and a passion...Remote 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
$60.15 - $85.81 per day
...Utilization Management NurseThe Utilization Management Nurse supports the case management department by providing a variety of... ...coverageHybrid Position – Primarily remote/work-from-home, with an... ...preferred)Licenses and Certifications:RN - Registered Nurse License - CA-BRN...Remote workFull timeWork experience placementWork from homeShift work- ...Optum is a global organization dedicated to improving health outcomes through care and technology. The Utilization Management Nurse will extract details from patient records and craft persuasive appeal letters per guidelines, within required timeframes. The role offers...Remote workMonday to FridayFlexible hours
- ...The Utilization Management Nurse supports the Case Management Department by performing a variety of utilization... ...coverage Hybrid Position – Primarily remote/work-from-home, with an expectation to... ...Current Registered Nurse (RN) license in the State of California (required...Remote workFull timeWork from homeShift work
- ...in the United States is seeking an Inpatient Utilization Management Clinician to evaluate inpatient medical necessity... ...planning across care teams. This fully remote, full-time role requires an active RN license, nursing degree, and experience with InterQual guidelines...Remote workFull time
- ...Utilization Management Registered Nurse (UM RN) We're seeking a dedicated and detail-oriented Utilization Management Registered Nurse (UM RN) to join our... ...regulations (LCD/NCD policies). This is a fully remote opportunity requiring discipline, accuracy, and effective...Remote work
- ...Utilization Management Department (Fully Remote)Provides health care services regarding admissions, case management, discharge planning and utilization review.Reviews admissions and service requests within assigned unit for prospective, concurrent and retrospective medical...Remote work
- ...Holding Company, Inc. is seeking a UM Nurse to support network adequacy review... ...authorization for ACO, HMO, and EPO products. Remote role with occasional onsite meetings in Somerville, MA. Requires MA RN license and 2–3 years of utilization review experience. You will review...Remote work
- ...Akron Children’s Hospital is seeking a Utilization Management Nurse to perform medical necessity reviews and ensure proper use of hospital resources... ...and discharge planning. The position requires a BSN and RN licensure with at least 3 years of inpatient experience, including...Remote work
- ...Seeking a full-time remote Utilization Management RN, the successful candidate will manage medical record reviews and denial documentation, develop... ...standards Required Qualifications Current, active Registered Nurse (RN) license 3+ years of bedside nursing experience in...Remote workFull time
- ...UnitedHealth Group is seeking a Utilization Management Nurse to review medical records and craft defensible appeal letters. The role supports telecommuting from anywhere in the U.S. and requires a state RN license, 3+ years bedside nursing, and strong data extraction skills...Remote work
- ...Utilization Review Nurse Astrana Health is looking for a CA-licensed Utilization Review Nurse to... ...respective to various Health Plans. This is a remote position for CA-licensed nurses.... ...one year of outpatient Utilization Management experience in a fast-paced setting....Remote workLive in
- ...To support a centralized Utilization Management department, the full-time Utilization Review Nurse will conduct timely utilization review activities, ensuring appropriate... ...with regulatory requirements while working remotely. Key responsibilities: Conduct medical...Remote workFull time
$71.1k - $97.8k
...About This Role The Utilization Management Nurse utilizes clinical nursing skills to support the coordination... ...: $71,100 - $97,800/year Location : Remote, LA Department/Unit : Care Management... ...to six weeks. Requirements Education: RN License in the state of Louisiana...Remote workFull timeTemporary workMonday to Friday- ...Find your calling at Mercy! Overview Utilization Management for the assigned inpatient Care Management population. This position is designed... ...Education: Graduate of an accredited school of nursing. Licensure: Current license in the state of residence and...Remote workRelief
- ...a Friend Back Remote Work from Home Share... ...MD 21076 Category: Nursing Schedule: Day Shift... ...Health Plans (JHHP) is the managed care and health... ...AM - 5:00 PM As a Utilization Review Registered Nurse... ...Unencumbered Registered Nurse (RN) license in Maryland (...Remote workFull timeLocal areaWork from homeMonday to FridayDay shift
- ...Full Time 40 hours/week remote Summary: The Utilization Management Nurse is responsible for conducting medical necessity review to assure appropriate use of hospital resources and serving as a resource to the hospital staff on utilization management practices...Remote workFull time
- ...Utilization Management RN (Part-Time, Remote) Position Overview Under the direction of a designated manager, the Utilization Management RN... ...Discharge Planning Case Management Inpatient Acute Care Nursing Care Coordination Telephonic Clinical Review...Remote workPart timeMonday to Friday
$26.01 - $56.14 per hour
...something bigger – helping to simplify health care one person, one family and one community at a time. Registered Nurse (RN) – Utilization Management Remote | Work from Home | 24/7 Operations Are you an experienced Registered Nurse looking to apply your clinical...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeAfternoon shift- ...Utilization Management RN Remote I'm currently working on a Utilization Management RN opportunity with a health plan client, supporting a temporary assignment during their Epic Tapestry system implementation and optimization. This is a contract role starting 10/15/...Remote workContract workTemporary workMonday to FridayShift work
$143.1k - $165.05k
...Utilization Management Nurse Burlingame, CA 94010 Overview Salary Range $143,098.80 - $165,048.... ...willingness to make decisions within RN's clinical scope of practice; exhibit... ...patient's home which may be in understaffed/remote areas, in the presence of pets or...Remote workWork at office$32.01 - $68.55 per hour
...person, one family and one community at a time. Registered Nurse (RN) – Utilization Management Join a dynamic healthcare team where your clinical... ...7pm), weekends, and holidays (based on business needs). Remote/office-based environment with extensive computer and telephone...Remote workHourly payFull timeTemporary workWork experience placementWork at officeLocal areaWork from homeMonday to FridayAfternoon shift$60k
...a LPN/LVN experienced in the managed care payor environment to perform... ...pre-service and post-service utilization reviews and appeals for... ...KNOWLEDGE/SKILLS/ABILITIES The UM Nurse’s responsibilities include... ...Career development opportunities Remote Opportunities We are actively...Remote workTemporary workLocal area
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