Remote Utilization Management Nurse (RN) - Inpatient Claims
Amerit Consulting
Amerit Consulting is seeking an experienced Utilization Management Nurse (RN) in California for a remote 6-month contract. The incumbent will support inpatient utilization review, medical necessity determinations, and facility claims compliance, auditing DRG classifications and reviewing hospital bills.
The ideal candidate holds an active California RN license with at least 5 years of relevant experience, performing concurrent or post-service inpatient reviews, and communicating findings to
#J-18808-Ljbffr- ...Medicare, and Medicaid health plans, seeks an experienced Utilization Management Nurse (RN) for a remote opportunity supporting inpatient utilization review, medical necessity determinations, and facility claims compliance. Duration: 6 Months Contract with Possible Extension...Remote workClaimsContract workTemporary workWork at officeLocal area
- ...Sentara Health Plans is hiring a Clinical Claims Reviewer/RN for a remote role. This full-time position involves utilization management and post-payment review across various care settings, with RN licensure and coding credentials under consideration. The role offers...Remote workClaimsFull time
- ...UnitedHealth Group is seeking a SSBV Clinical Claims Review RN for a remote role nationwide. You will perform administrative reviews of inpatient hospital claims, document... ...criteria to support member care and cost management. The role offers autonomy with accountability...Remote workClaims
$34 - $35 per hour
Utilization Management - Clinical Nurse - Work from Home! Utilization Management... ...precertification of inpatient hospitalizations and... ...reviews Qualifications RN license in an eNLC (... ...Prior Authorization Remote Registered Nurse (... ...Manager Clinical Claims Nurse (Healthcare Provider...Remote workClaimsFull timeWork at officeWork from homeNight shift- ...Sentara Health Plans is seeking an RN Clinician for remote utilization management and claims review. You will perform pre/post payment reviews, authorizations, and post-payment inquiries in a compliant manner with NCQA, CMS, DMAS guidelines. Requires a BSN and 3 years...Remote workClaims
- ...CorVel is seeking a Utilization Review Case Manager to gather demographic and clinical data for in-... ...Management department’s goals. This remote role requires RN licensure and 4+ years of clinical... ...emphasizes collaboration with claims staff, physicians, and clients, strong...Remote workClaims
- ...Blue Zones Health is seeking an LVN for Utilization Management & Inpatient Case Management in a fully remote role. The ideal candidate will perform concurrent reviews... .... Requirements include CA LVN license, 3+ years nursing experience, and knowledge of CMS/Medicare...Remote work
- ...Alignment Health is seeking an inpatient review nurse to join the remote utilization management team. You will assist patients through the continuum of care in collaboration with the patient’s PCP, facility case manager, discharge planner and contracted providers to ensure...Remote work
- ...Alignment Health is seeking an inpatient review nurse to join the remote utilization management team. As an inpatient review nurse, you will assist patients through... ..., 8:00 AM - 5:00 PM Pacific Time. Requires LVN or RN license (CA or willing to obtain in other states)...Remote workMonday to Friday
- ...Utilization Management Department (Fully Remote) Provides health care services regarding admissions, case management, discharge planning and utilization... ...records/documentation, precertification, reimbursement and claim denials/appeals. Assesses and coordinates discharge...Remote workClaims
- CorVel Corporation is seeking a Utilization Review Case Manager for a remote role. The ideal candidate holds an RN license and has 4+ years of clinical experience with utilization... ...on certification, and collaboration with claims staff and stakeholders. Applicants should be...Remote jobClaims
$90 - $110 per hour
...Washington D.C., and Nashville. Remote work is allowed. Role Overview Epic Tapestry Utilization Management (UM) Analyst We are... ...prior authorizations, referrals, inpatient admissions, concurrent reviews... ...teams, including Tapestry Claims, Membership, Provider Management...Remote workClaimsHourly pay$65k - $85k
...All Jobs Licensed Vocational Nurse (LVN) - Utilization Management & Inpatient Case Management Licensed Vocational Nurse... ...& Inpatient Case Management Fully Remote Remote Worker - N/A Full-time Description... ...clinical review and elevate to an RN, Medical Director, or other...Remote workFull timeWork at office- ...Requirements: Licensed Practical Nurse (current unrestricted,... ...for review by the utilization review specialist.... ...memo to the claims office advising of the... ...discuss potential case management referrals with the case... ...Review Coordinator LPN (Remote) Support Job Utilization...Remote workClaimsFull timeTemporary workWork at office
$57.24k - $62.18k
...Description Nurses – are you looking... ...in personalized managed health care,... ...life balance. ~ Remote setting... ...individual will utilize clinical knowledge... ...outpatient treatment or inpatient confinement.... ..., benefit and claim concerns, and... ...not limited to RN, LMSW, LMHC....Remote workClaimsFull timeTemporary workWork at officeMonday to FridayFlexible hours- Alignment Health is seeking an inpatient review nurse to join our remote utilization management team. You will assess inpatients and collaborate with physicians, case... .... Qualified candidates will hold an active LVN or RN license, have at least 3 years in case management,...Remote job
- Alignment Health is seeking an inpatient review nurse to join the remote utilization management team. You will guide patients through the continuum of care, coordinating with physicians, case managers and service providers to ensure safe, cost-effective care aligned with...Remote job
$1,759.5 per week
...Travel RN - Case Management/Utilization Review American Traveler Austin, Texas, United States Position... ...Management RN for a fully remote role requiring TX or compact RN licensure... ...precertification, reimbursement, and claims denial/appeal issues Coordinates discharge...Remote workClaimsWeekly payLocal areaShift work- Blue Zones Health seeks a Licensed Vocational Nurse (LVN) for Utilization Management & Inpatient Case Management in a fully remote role based in California. You will monitor inpatient services, perform concurrent reviews, and coordinate transitions of care while collaborating...Remote job
$42 per hour
...Centralized acute admission utilization review across 13 acute... ...of unit: Utilization Management Number of beds on the... .../Experience: Licensed RN (multistate or TX RN),... ...insurers, Google Workspace, remote work experience Other... ..., reimbursement, and claim denials/appeals....Remote workClaimsWork experience placementMonday to Friday$100k - $130k
...who need it most. The Utilization Management (UM) team plays a... ...guidelines. As the Lead RN, Utilization... ...Utilization Management nurses and clinical reviewers... ...Grievances, Care Management, Claims, Provider Relations,... ...Additionally, we embrace a remote-first culture that...Remote workClaimsFull timeWork experience placementWork at officeFlexible hours- ...Inpatient Utilization Management ClinicianThe Inpatient Utilization Management... ...utilization review nurses and participate in... ...accurately for proper claims adjudication.Identify... ...Active, unrestricted RN license in state of residence... ...independently in a remote environment while...Remote workClaimsWork at officeNight shiftAfternoon shift
$83k - $99k
...Role and Responsibilities The Utilization Management Nurse collaborates with external... ...monitoring of member utilization and claim patterns; and makes... ...professional experience Active LPN/RN clinical license required 1-... ...$600 wellness reimbursement Remote work and continuing...Remote workClaimsFull timeWork at officeFlexible hours- ...Sentara Health Plans is seeking a Clinical Claims Reviewer/RN for a remote, full-time position. Responsibilities include utilization management, pre/post payment claim reviews, and authorization assessments across inpatient and outpatient cases, with regulatory compliance...Remote workClaimsFull time
- ...timely and evidence-based utilization review services, the full-time Utilization Review RN will work remotely to manage complex medical conditions... ...Collaborate with physicians, claims examiners, and other... ...preferred Bachelor's degree in nursing (BSN) from an accredited...Remote workClaimsFull timeWork experience placement
- ...benefit determinations, the full-time LVN Utilization Review Nurse will conduct first-level clinical... ...outpatient pre-certification requests and inpatient hospital stays to assess medical... ...clinical experience Knowledge of medical claims and ICD-10, CPT, HCPCS coding...Remote workClaimsFull timeWork at officeMonday to Friday
- ...Senior Clinical Specialist Pharmacist to join our team remotely in the United States. This role focuses on delivering... ...drug information, handling prior authorization and utilization management, and supporting claims adjudication alongside external affairs projects. The...Remote workClaims
$70k - $75k
Utilization Management Registered Nurse (RN) - Remote Full-time WHO IS GUIDEHEALTH? Guidehealthis a data-powered, performance-driven healthcare company... ...Appropriate treatment plans Intensity and duration of inpatient or outpatient services Quality of care concerns...Remote workBi-weekly payFull timeTemporary workFor contractorsLocal areaWork from home$28.2 - $38.2 per hour
...Are Looking For Every day, Cambia’s dedicated team of Utilization Management Inpatient (UM IP) Clinical Specialist are living our mission to make... ...healthcare systems and documentation, EMRs, billing, and claims, with a preference for significant prior experience...ClaimsWork at officeImmediate startWork from homeFlexible hours- ...Join Ladders as a Pharmacist in Utilization Management to support medication coverage decisions by... ...evaluating prior authorization requests. This remote role requires a Bachelor's degree in... ...will ensure compliance and accurate claims processing while protecting...Remote workClaims
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