Remote RN: Clinical Quality & Utilization Reviewer
TEEMA
TEEMA is seeking a Registered Nurse for a remote role with Arizona hours (1st shift). You will review medical records for quality, safety, and utilization issues, identify PQIs, and support QA initiatives in collaboration with Medical Directors.
Must hold an active RN license, have 3+ years of clinical experience in med/surg or behavioral health, and be eligible for DoD background clearance. Experience with health plans or large healthcare systems and data analysis or reporting exposure is
#J-18808-Ljbffr$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-LjbffrRemote workQualityHourly pay- Comagine Health is seeking a Clinical Utilization Review Nurse (RN) for a 100% remote, full-time role supporting Alaska contracts. The nurse will assess medical necessity and care quality through prospective, concurrent, and retrospective reviews, applying InterQual criteria...Remote jobQualityFull time
$117.9k - $152.57k
...Documentation Integrity Specialist IV, Clinical Licensure-Risk Adjustment-RN Primary Location... ...1444442 Worker Location: Remote Submit Interest Description: Job Summary: Reviews a moderate caseload of... ...medical review and coding, quality standards, documentation requirements...Remote workQualityFull timeLocal areaShift work- Top Healthcare company is hiring a RN Clinical Document Improvement Specialist! Remote Position! ***Required Certified... ...an experienced second-level CDI reviewer and subject matter expert,... ...liaison for the CDI, Coding, and Quality Teams. Assists with on-going education...Remote workQualityFull timeTemporary workWork experience placementFlexible hoursDay shift
$112.7k - $193.2k
...opportunities with Kelsey-Seybold Clinic, part of the Optum... ...to help drive higher quality, higher patient... ...operational oversight for all Utilization Management functions,... ...inpatient utilization review, outpatient prior authorization... ...Registered Nurse (RN) license or valid...Remote jobQualityMinimum wageFull timeContract workWork experience placementLocal area- ...Behavioral Health Utilization Reviewer The Behavioral Health Utilization... ...responsible for conducting clinical reviews of behavioral health... ...Analyze BH member data to improve quality and appropriate utilization... ..., or behavioral health RN license in Louisiana can replace...Remote workQualityWork at office
- ...Role Overview Our Utilization Management Reviewers evaluate medical necessity... ...aligns with clinical guidelines, regulatory... ...established turnaround times, quality benchmarks, and... ...to obtain additional RN licensure across the... ...work solutions include remote options, hybrid work...Remote workQualityMonday to FridayFlexible hoursWeekend work
- ...A peer review organization is seeking a full-time remote Utilization Management Physician Reviewer. Ideal candidates must hold... ...and providing guidance on clinical questions. This is a unique opportunity... ...home while contributing to quality medical reviews. #J-18808-...Remote workQualityFull timeWork from home
$86k - $117.3k
...roles that are 100% remote or hybrid, you must have... ...of a supervisor, the Utilization Management Reviewer evaluates medical... ...treatment aligns with clinical guidelines, regulatory... ...turnaround times, and quality standards in a high-... ...unencumbered Registered Nurse (RN) license in the...Remote workQualityHourly payContract workMonday to FridayFlexible hoursWeekend work2 days per week- ...Remote Hialeah, FL Miami, FL Full time... ...staff position, please review this tip sheet ( . The Clinical Documentation... ...resource for CDI/Coding/Quality. The CDI Second Level... ...documentation by utilizing queries that are effective... ...Licensing:Current RN or MD required; CCDS...Remote workQualityFull timeTemporary workWork at officeWorldwide
- Comagine Health is seeking a Clinical Reviewer with LCSW/LPC/LCPC licensure for a remote, Oregon-based role requiring travel... .... The position emphasizes utilization review, documentation, and collaboration... ...stakeholders while supporting quality initiatives. #J-18808-Ljbffr...Remote jobQualityWork from home
- ...company is seeking a Physician to provide utilization review services for the Group Health Department. This role requires utilizing clinical expertise to review medical records and... ...the due date and time. Assist with quality assurance of reports prior to submission...Remote workQuality
- Comagine Health is seeking a Clinical Reviewer to work remotely from Oregon with travel across the Eugene... ...ensuring timely decisions and high-quality care. The role requires licensure,... ...behavioral health, and familiarity with utilization review. #J-18808-Ljbffr Comagine...Remote jobQuality
- Coastal Care Services, Inc. is seeking an LPN licensed Utilization Management Nurse Reviewer for a work-from-home opportunity serving the Miami, FL area... ...physicians, patients and families to assure cost-effective, high-quality #J-18808-Ljbffr Coastal Care Services, Inc.Remote jobQualityWeekday work
- ...Orthopedic Spine Surgeon Reviewer Dane Street, a nationally recognized... ...Board Certification to conduct Utilization Reviews. This is a fully remote, non-clinical role offering supplemental income... ...practicing physicians to ensure high-quality, evidence-based clinical...Remote workQualityPrice workExtra incomeFor contractorsFlexible hours
- ...Clinical Supervisor, UM Denial Compliance Location:... ...Position Type: Hybrid (85% remote, 15% onsite in Burbank,... ...in ensuring a high-quality, efficient, and compliant... ...tasks, performance reviews, and disciplinary actions... ...Registered Nursing Program; RN preferred. Minimum...Remote workQualityPermanent employmentTemporary work
- ...Clinical Documentation Improvement Specialist Work Mode: Remote Duration: 6-9 months Full-time, day shift... ...Responsibilities: Utilize clinical/nursing knowledge to improve the quality and completeness of clinical... ...: Current, valid AZ RN or LPN license or valid...Remote workQualityFull timeFlexible hoursDay shift
$219k - $286.9k
...We're hiring a Physician Reviewer to join our Utilization Management team. Oscar... ...pharmacy services by reviewing clinical information and applying... ...Work Location: This is a remote position, open to... ...that meet Oscar's stringent quality parameters. Provide clinical...Remote workQualityFull timeLocal areaWork from homeHome officeWeekend work$34 - $35 per hour
Utilization Management - Clinical Nurse - Work from Home! Utilization Management... ...and concurrent review of hospitalizations and... ...facilities to promote quality service and care... ...reviews Qualifications RN license in an eNLC (Enhanced... ...Prior Authorization Remote Registered Nurse (...Remote workQualityFull timeWork at officeWork from homeNight shift$60.2k - $107.4k
...improving risk management, quality and revenue growth.... ...and retrospective chart reviews for improving the overall completeness of clinical documentation Keep... ...trends Effectively utilizes ICD-10 and related materials... ...Qualifications: ~ RN License (BSN Required)...Remote jobQualityMinimum wageFull timeWork experience placementWork at officeLocal area- ...Job Title: Utilization Management Registered Nurse (UM RN) – SNF / MLTC Location: Remote (Must reside in NY, NJ, or... ..., you will evaluate clinical documentation, assess... ...conducting utilization reviews within a SNF, health... ...determinations. Quality & Appeals: Identify...Remote workQualityFull timeMonday to Friday
- ...Description: Manager of Clinical Utilization Management - Denial... ...Position Type: Hybrid (85% remote, 15% onsite in... ...daily tasks, performance reviews, and any necessary disciplinary... ...and enhance the quality of the denial process... ...Nursing Program; RN preferred. 2. Minimum...Remote workQualityPermanent employmentFull timeTemporary workFlexible hours
- TEKsystems is seeking a Clinical Quality Assurance Coordinator for a fully remote, contract-to-hire position. You will... ...Requirements include active RN licensure, utilization management experience, and 2-... ...rigorous documentation across reviews. #J-18808-Ljbffr TEKsystemsRemote jobQualityContract work
- ...Utilization Management RN (Part-Time, Remote) Position Overview Under the direction... ...RN performs telephonic review of hospital admissions and... ...supports efficient, high-quality utilization of healthcare... ...of stay using established clinical criteria Direct care...Remote workQualityPart timeMonday to Friday
$66.58k - $142.58k
...accountable and prioritize safety and quality in everything we do. Join us... .... Position Summary The Clinical Team Lead in the Utilization Management team utilizes... ...May be required to proctor RN/MD rounds. Assists with escalated case reviews/facility issues. Gathers...Remote workQualityHourly payFull timeTemporary workWork at officeLocal areaAfternoon shift$35.29 - $54.71 per hour
...CO Department: Clinical Care Annex Work... ...offer a hybrid or remote option Minimum... ...Registered Nurse (RN). ~6 months of nursing... ...patient care utilizing the nursing... ...secure safety and quality at the point of care... ...living. Market reviews: All UCHealth positions...Remote workQualityFull timeTemporary workLocal areaFlexible hoursShift work- ...Health in Oregon is seeking a Supervisor, Clinical CM to provide operational supervision of clinical staff performing utilization reviews and specialty reviews using InterQual... ...stakeholders. This role supports a flexible remote work model with occasional on-site collaboration...Remote workQualityFlexible hours
$40 - $52 per hour
...Clinical Data Coordinator/OASIS Review VNA Health Group is seeking an experienced Registered Nurse to join... ...leadership team • Opportunity to impact quality outcomes across the organization... ...initiatives Qualifications • Current NJ RN License required • BSN preferred...Remote workQualityWork experience placementWork at officeLocal area$65k - $85k
...Concierge Home Care | Remote Opportunity | Growth Opportunities... ...for an experienced Utilization Review Specialist (RN) to join our remote home health... ...’ll Do Review home health clinical documentation for accuracy... ...field clinicians Support quality assurance and regulatory...Remote workQualityMonday to FridayWeekend workWeekday work$72.8k - $130k
...occasional opportunity for remote work based on business needs. As a Sr Utilization Management Nurse in... ..., and promoting quality patient care. Responsibilities... ...discuss care details, reviewing clinical information for... ...be a Registered Nurse (RN) with a current, active...Remote workQualityMinimum wageFull timeWork experience placementCasual workLive inWork at officeLocal area
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