Remote Utilization & Case Management Lead (RN/MD)
Mercor Inc
Mercor connects elite creative and technical talent with leading AI research labs. A remote Utilisation Management leader role is available, requiring RN licensure and physician-advisor experience.
Contract position with high-level responsibility and collaboration across payers and clinical teams. The role emphasizes overseeing concurrent and retrospective reviews, discharge planning, and AI-enabled decision-support validation, with strong English communication skills and meticulous attention to
#J-18808-LjbffrVacancy posted 3 days ago
Similar jobs that could be interesting for youBased on the Remote Utilization & Case Management Lead (RN/MD) in United States vacancy
$100k - $130k
...those who need it most. The Utilization Management (UM) team plays a vital role... ...CMS guidelines. As the Lead RN, Utilization Management, you... ...and clinical reviewers; use case audits and feedback to... ...Additionally, we embrace a remote-first culture that supports...Remote workFull timeWork experience placementWork at officeFlexible hours- ...population. This includes utilization management, patient advocacy, and... ...accuracy.The Team Lead of On-site UM is responsible... ...is expected that all RN Clinical Nurses are... ...compliance. Unlike remote roles, this position relies... ...providers to discuss cases where documentation...Remote workFull timeImmediate startShift work
Wellstar Health Systems, Inc.
Marietta, GAa month ago - ...Leading a team of clinical professionals, the remote Lead RN, Utilization Management will coach and develop staff, oversee daily review operations, and ensure compliance with... ...reviewers while supporting staff development through case audits and feedback Manage daily workloads...Remote work
Virtual Vocations Inc
United States5 days ago - ...Centene is seeking an experienced Supervisor of Utilization Management to lead the Prior Authorization, Concurrent Review, and Retrospective Review teams. This remote role supports members across the health plan with a focus on quality and compliance. You will supervise...Remote work
Centene Corporation
United States10 hours ago $1,464 - $1,559 per week
...Registered Nurse (RN) | Utilization Review Location: Baltimore, MD Agency: GQR Healthcare Pay: $1,464... ...Maryland, 21224! Contract - W2 Case Management/Utilization Review Registered Nurse... ...make a real impact. We are a leading healthcare staffing provider, specializing...SuggestedHourly payWeekly payFull timeContract workImmediate startShift workTravelNurseSource
Baltimore, MD9 days ago$89.07k - $162.8k
...and retrospective case reviews to ensure appropriate... ...level of care by utilizing the nationally... .... This position is remote but must be willing... ...living in the DC, MD or VA area is... ...discipline including risk management quality safety and... ...: RN - Registered Nurse...Remote workMedStar Health
Washington DC5 days ago- ...population. This includes utilization management, patient advocacy, and... ...accuracy. The Team Lead of On-site UM is... ...is expected that all RN Clinical Nurses are licensed... ...administrative compliance. Unlike remote roles, this position... ...providers to discuss cases where documentation...Remote workImmediate startShift work
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United States4 days ago - Ensemble Health Partners is seeking an RN Utilization Review quality professional to lead QA efforts within the VUR team. You will mentor staff, evaluate QA... ...and knowledge of medical necessity review criteria. Remote work with travel to client sites is expected, and opportunities...Remote job
- ...KPC Global Medical Centers Inc. in Hemet, CA is seeking a Utilization Review RN to review client health records and ensure proper utilization of treatment resources. The position supports case management and cross-team collaboration to optimize patient care and data...Shift work
Kpc Global Medical Centers Inc.
Hemet, CA8 hours ago - ...seeking a Nurse Reviewer Supervisor to oversee utilization staff and ensure compliant medical necessity... .... The position requires an Ohio RN license, 7+ years of RN experience in utilization review or case management, and leadership capabilities. #J-18808-Ljbffr
Superior Dental Care
Cleveland, OH4 days ago - ...initiatives, the full-time Florida Licensed Utilization Management RN will monitor admissions, perform... ...multidisciplinary care team in a fully remote setting. Key responsibilities Monitor... ...in Utilization Management or Case Management (Preferred) Registered Nurse...Remote workFull time
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United States2 days ago - ...Job Title: Utilization Management Registered Nurse (UM RN) – SNF / MLTC Location: Remote (Must reside in NY, NJ, or CT) Schedule: Monday – Friday, 9:00 AM – 5:00 PM... ...physicians, nurse practitioners, social workers, case managers, therapists, and facility leadership...Remote workFull timeMonday to Friday
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New York, NY2 days ago - ...Providing timely and evidence-based utilization review services, the full-time Utilization Review RN will work remotely to manage complex medical conditions, treatment planning,... ...work experience preferred Certification in case management, pharmacy, rehabilitation...Remote workFull timeWork experience placement
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United States3 days ago - ...Logan Health is hiring a Utilization Management Specialist to join the UM team. The role focuses on... ...You will collaborate with physicians, case management and insurers to authorize care... ...proficiency, with a four-day work week and remote options for Montana residents. #J-188...Remote work
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United States2 days ago - ...Health Medical Center is seeking a Utilization Management Specialist to review... ...appropriate status. This role suits an RN or Social Worker with acute... ...with physicians, case management and insurers. The position is fully remote for Montana residents and offers...Remote work
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United States5 days ago- ...University of Miami Health System seeks a full-time Utilization Review Case Manager to work remotely. The role reviews patient charts for prior authorization, concurrent and retrospective utilization, coordinating with the care team for timely and appropriate care....Remote workFull time
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Street, MD5 days ago $1,798 per week
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Baltimore, MD1 day ago- Methodist Hospital for Surgery in Addison, TX is seeking an RN Utilization Review Coordinator in the Case Management department. The role performs prospective, concurrent, and post-discharge reviews to ensure medical necessity and regulatory compliance. You will collaborate...
$52 - $56 per hour
...both. We're hiring a contract RN for a New York health plan (Medicare... ...medical necessity judgment you built in utilization management. 100% remote (U.S.) | Contract | $52–$56/hr based... ..., home health, DME and LTSS cases Prepare case files for Medical...Remote workContract workAfternoon shiftPhaxis
United States4 days ago- ...System, serving Southern Nevada, seeks an experienced RN for Utilization Review to lead discharge planning and ensure efficient resource use.... ...clinical settings and preference for Utilization Review/Management or Case Management experience. Excellent benefits provided. #J...
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Oklahoma Heart Hospital, L.L.C.
Oklahoma City, OK10 hours ago - ...an experienced Registered Nurse to lead discharge planning and utilization management, ensuring safe patient transitions... ...Qualified candidates will have a Nevada RN license, at least three years of... ...in utilization review, utilization management or case #J-18808-Ljbffr...
Universal Health Services
Las Vegas, NV3 days ago - ...Universal Health Services is seeking a Case Manager (RN) at Aiken Regional Medical Centers in South Carolina. The role focuses on admission... ...with a multidisciplinary team, and ensuring appropriate utilization of hospital days. Required is a RN license (SC or Compact) with...
Universal Health Services
Columbia, SC4 days ago - ...Travel RN - Case Management/Utilization Review - Case ManagementAmerican TravelerFort Myers, Florida, United StatesPosition status: OpenAssignment... ...after submissionOrientation begins on a Friday, including remote orientation and an in-person visit for badge/IDCandidates...Remote workWeekly payFull timeShift workDay shift
American Traveler
Fort Myers, FL3 days ago $72.5k - $90.6k
...Quartz is seeking a Utilization Management RN Case Manager to review prior authorization requests, coordinate transitions, and collaborate with physicians... ...with no weekends or holidays, with in-person, hybrid, or remote options and a pay range of $72,500–$90,600. Wisconsin...Remote workMonday to FridayQuartz
Madison, WI4 days ago- ...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...Remote workFull time
Guidehealth
United States4 days ago - ...Responsibilities As our Utilization Review RN, you will meticulously review... ..., delegate effectively, and manage time efficiently. Your meticulous... ...This position is open to remote/out of state candidates... ...experience or a Masters degree in Case Management or Nursing field...Remote work
CommonSpirit Health
Longmont, CO5 days ago - ...CorVel in the United States is seeking a Utilization Review Case Manager to gather demographic and clinical information, certify medical necessity... ...length of stay for inpatient and outpatient treatment. This remote role requires strong CPT/ICD coding knowledge, meticulous...Remote work
NurseRemotely
New York, NY3 days ago
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