Remote Medicaid Ops Specialist III-Epic Utilization Review
$30 - $45 per hourPyramid Consulting, Inc
A leading healthcare consulting agency is seeking an Operations Specialist III for a contract opportunity in Long Beach, CA. This role requires expertise in Medicaid and Medi-Cal operations, along with experience in Epic EHR and Utilization Review. The selected candidate will perform chart reviews, ensure documentation accuracy, and support Medicaid program metrics. This position is remote and offers a pay range of $30-$45 per hour with various employee benefits including health insurance and a 401(k) plan. #J-18808-Ljbffr
$30 - $45 per hour
...Immediate need for a talented Operations Specialist III – Medicaid / Medi-Cal (Epic + Utilization Review. This is a 06+months contract opportunity with long-term potential and is located in Long Beach , CA(Remote). Please review the job description below and contact...Remote workEpicContract workLocal areaImmediate start- ...Experience Required - Remote work for TX, AR, WI and... ...purpose of the Coding Specialist III is to code and verify... ...reimbursement (Medicare and Medicaid) principles. •... ...CAC). • Knowledge of Epic EHR and 3M 360 coding... ...% accuracy on quality reviews and meet assigned productivity...Remote workEpicContract workLocal area
$60k - $70k
...process. Full Time Office/Clerical Remote, Birmingham, AL, US Salary Range:... ...of the journey. We are seeking a Utilization Review Specialist to add to our dynamic team! The Utilization... ...with commercial insurance, Medicare, Medicaid, Managed Medicaid, TRICARE, Veterans...Remote workFull timePart timeWork at office- ...Utilization Review Nurse Location: [City, State / Remote] Employment Type: Full-Time Experience: 2-5+ Years... ...compliance with CMS, Medicare, Medicaid, Joint Commission, and other regulatory... ...payer audits.Familiarity with Epic, Cerner, Meditech, or other...Remote workEpicFull timeSecond jobWork at office
$68.89k - $92.14k
...Pay Plan Title: Utilization Management Specialist III Working Title: Utilization Management Specialist III... ...68,890- $92,138 Office Location: Remote within North Carolina POSTING DETAILS... ...providing comprehensive clinical review of services requests for people who...Remote workFull timeWork at officeLocal areaImmediate startWork from homeFlexible hours$2,147 per week
...Travel RN - Case Management/Utilization Review American Traveler Somerville... ...Traveler is hiring a remote RN for Utilization Management... ...utilization review decisions Epic EMR preferred... ...required ~ Experience with Medicaid, Medicare, and Commercial lines...Remote workEpicWeekly payLocal areaMonday to FridayShift work- ...Registered Nurse – Utilization Review (Remote) Position Overview: This is a fully remote Utilization Review RN role supporting multiple service... ...without this will not be considered. Proficient in Epic, with recent use within the last 6–12 months. Experience...Remote workEpic
- ...Access Specialist I- OB/GYN Work Arrangement... ...(On-Site and Remote mix) Location: Durham... ...conflict, utilizing emotional intelligence... ...not limited to: EPIC, Cadence, Op-time, Template changes... ...or Out-of-County Medicaid, Veterans... ...for a financial review and trace the progress...Remote workEpic
- ...Job Description: The Utilization Review Specialist nurse (UR RN) is responsible for monitoring adherence to the Utilization Review Plan (UR Plan... ...On-site required Must be proficient in in both EPIC and InterQual programs Position Urgency: Normal...EpicContract workMonday to FridayFlexible hoursShift workWeekend work
- ...Job Title In this remote role, you will perform utilization reviews, ensuring compliance with clinical guidelines and patient care standards. Collaborate... ...determination and familiarity with charting systems like Epic will be essential. This position offers flexibility...Remote workEpicWeekly pay
- ...Northpoint Recovery Holdings, LLC is seeking a licensed Utilization Review Specialist to ensure clinically appropriate care, discharge planning, and cost-effective utilization across the treatment continuum. You will lead reviews of admissions, stays, discharges, and appeals...Remote work
- ...BJC HealthCare is seeking a registered nurse to join a remote Utilization Review team. The role supports multiple hospital units with no patient... ...to five years of inpatient nursing experience and UR experience are required; EPIC experience preferred. #J-18808-Ljbffr...Remote workEpicLocal areaWeekend work
- ...Recovery Unplugged is seeking an experienced Utilization Review Specialist to join our team. This remote, part-time role focuses on obtaining and maintaining insurance authorizations, communicating with managed care organizations, and collaborating with clinical teams....Remote workPart timeWeekend work
$65 per hour
...Fully Remote Position Job Title : RN - UTILIZATION REVIEW Location: Everett, WA 98201 Start Date: 05/04/2026 Duration: 13 weeks Schedule Shift:... ...campuses Scrub Color: Any (no reddish orange permitted) Charting: EPIC Parking Cost: Facility PaidRemote workEpicLocal areaImmediate startMonday to FridayShift workWeekend work- ...To support the treatment of addiction and mental health issues, the full-time Remote Utilization Review Specialist will manage pre-authorizations and concurrent reviews, collaborating with case managers and the multidisciplinary treatment team to ensure compliance with...Remote workFull time
- ...and substance use treatment, the full-time Behavioral Health Utilization Review Specialist will verify benefits, complete prior authorizations, and support medical necessity criteria while working remotely. Key responsibilities Verify insurance benefits, eligibility,...Remote workFull time
$24.65 - $30.03 per hour
...team! Responsibilities The Utilization Review Tech essentially works to... ...CERT, ADR, Pre/Post Probes, QIO/Medicaid) and other payer audits as assigned. UR tech III will also function as an SME to support the UR tech team and remote counterparts with the specific...Remote workFull timeWork at officeLocal areaShift work- ...and streamlined manner. We are seeking to add an ABA Utilization Review (UR) Specialist to our growing team. The ABA UR Specialist will utilize his... ...a cohesive and rewarding environment. This is a fully remote or office/home hybrid position. Your Responsibilities:...Remote workWork at officeFlexible hours
$40k - $50k
...Job Type Full-time Description Utilization Review Specialist Full-Time- must be able to work a few weekends per month Location: Remote Preferred Residence: Candidates residing in Florida, Tennessee, Texas, Virginia, South Carolina, or New Jersey...Remote workFull timePart timeWork at officeWeekend work- ...Utilization Review (UR) Specialist Location: Open to candidates near Wyomissing PA & Chadds Ford PA (Hybrid / Remote Eligible) Job Type: Full-Time Schedule: Monday – Friday Diversified Treatment Alternative Centers (DTAC) is seeking a detail-oriented and experienced...Remote workFull timeMonday to FridayFlexible hours
- ...Mass Digital Health is seeking a Clinical Reviewer LPN for a work-from-home position. The... ...requiring clinical expertise and knowledge of Medicaid guidelines. Candidates must have an... ...setting, and the ability to work in a remote environment. Comprehensive benefits are...Remote workContract workWork from home
$30 - $35 per hour
...Location: Remote Schedule: Monday-Friday 8am-5pm MST Compensation: $30-35/hour Northpoint Recovery Holdings, LLC... ...POSITION SUMMARY: As a key member of the Northpoint team, the Utilization Review Specialist is a licensed professional who is responsible for ensuring...Remote workFull timeTemporary workFor contractorsWork at officeMonday to Friday- ...Optum is seeking a remote Behavioral Health Utilization Review Specialist to support case management and care coordination. This full-time, Monday–Friday role offers standard business hours with occasional on-call needs based on business requirement. The position requires...Remote workFull timeMonday to Friday
- ...Optum is recruiting a remote Behavioral Health Utilization Review Specialist to support case management for behavioral health and substance use. You will review cases, determine levels of care, and coordinate transitions between inpatient and outpatient settings. This...Remote workFull timeMonday to Friday
$1,946.5 per month
...Registered Nurse Specialty Utilization Review Job ID 38399697 Job Title... ...Charge Experience - Experience with Epic charting system (recent use within the... ...compliance - Unit Details: - 100% remote work environment - Rotation between...Remote workEpicWeekly payShift workWeekend workDay shift- ...Details POSITION SUMMARY - RN Utilization Review POSITION DUTIES - Review... ...hospital-based) ~ Skilled experience with remote work LENGTH OF ASSIGNMENT - 1... ...weekend rotation SYSTEMS - Epic, Dragonfly - DragonFly experience is required...Remote workEpicTemporary workShift workWeekend work
- ...Cohere Health seeks an experienced RN Reviewer to perform prospective, concurrent, and retrospective reviews ensuring... ...supporting cost-effective care for Commercial, Medicare, and Medicaid lines. The role is fully remote, requires strong communication, and entails 40 hours...Remote workFlexible hours
- ...WNS, part of Capgemini, seeks a remote Utilization Review Nurse to perform medical necessity reviews and collaborate with providers to ensure compliant patient care. The role emphasizes adherence to HIPAA, state and federal regulations, and a strong team-oriented environment...Remote workWork at office
$65k - $85k
...Concierge Home Care | Remote Opportunity | Growth Opportunities | Increased Earning Potential At Concierge Home Care, we are growing and looking for an experienced Utilization Review Specialist (RN) to join our remote home health team. This role is ideal for an RN with...Remote workMonday to FridayWeekend workWeekday work$2,158.8 per week
...Ref. 65547807 RN - Utilization Review $2,158.80 per week... ...dedicated RN - Utilization Review specialist for a travel assignment in Fort Myers, FL. This remote position requires expertise in... ...electronic medical records with Epic software Function as core...Remote workEpicWeekly payWork experience placementMonday to FridayFlexible hoursShift workWeekend work
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