Remote RN Utilization Management
$35 - $37 per hourThe Judge Group Inc
- Remote job
Get AI-powered advice on this job and more exclusive features. This range is provided by The Judge Group. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range $35.00/hr - $37.00/hr Direct message the job poster from The Judge Group. Job Title: Remote Registered Nurse (RN) - Temp to Perm Pay Rate: $36-37/hr Start Date: April 7th Licenses required: Compact AND California AND DC Job Summary: We are seeking experienced Registered Nurses (RNs) for a remote temp-to-perm opportunity. The RN will be responsible for completing quality audits of physician case reviews, supporting the clinical aspects of the review process, and resolving operational issues. This role requires a high level of technical skills and the ability to work with multiple programs concurrently. Responsibilities: Complete quality audits of physician case reviews using national medical guidelines (MCG, Interqual, etc.), evaluating the clinical aspects of cases and auditing for accuracy and completeness. Format reviews in accordance with specific formatting requirements. Support the clinical aspects of the review process. Resolve operational issues related to the clinical aspects of review cases. Communicate with assigned reviewers and treating/ordering practitioners/providers. Advise and provide guidance to reviewers on the operational aspects of review cases in all categories (i.e., standard, and ERO cases). Collaborate with the Chief Medical Director and Director of Provider Relations to address reviewer quality issues and support the Provider Relations assessment process. Maintain or exceed the established monthly production benchmark. Qualifications: Must have a compact/multistate license AND a CA single state AND a DC single state. Minimum 3 years of RN experience in a clinical setting with a preference for a broad scope of practice. Hospital bedside nursing experience in ICU, ER, Med/Surg, or Dialysis is required. Backgrounds limited to OR, Peds, L&D, Women’s services, etc., are not preferred. No travel RNs unless they have a stable work history (3+ years at the same facility) either prior to or after their travel assignments. No NPs, whether practicing or not. Utilization Review experience is helpful but not required; critical thinking skills are more important. Proficiency with computers is essential. Candidates will use three monitors (laptop and 2 additional screens) and multiple web-based systems with multiple passwords, as well as Teams, Outlook, and some data entry in Excel. Experience with Milliman or Interqual is a plus. Candidates should not need any extended time off during the first three months of training (approximately 2 months). Schedule: Monday – Friday, 8:00 AM – 4:30 PM MT, with rotating weekends (approximately one weekend every 6 weeks). Comp days will be provided during the week when working the weekend. Additional Information: Equipment will be provided. Seniority level Not Applicable Employment type Full-time Job function Health Care Provider and Administrative Industries Business Consulting and Services and Hospitals and Health Care #J-18808-Ljbffr The Judge Group
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$100k
...Work Experience 1-3 years Salary $100,000 Remote Job Job Description This is a remote position. The Utilization Management (UM) Nurse is responsible for conducting... ...maintain an active, unrestricted Registered Nurse (RN) license in the applicable state or possess a...Remote workContract workWork experience placement- Netsmart is seeking a Registered Nurse with solid utilization management experience to perform ED utilization reviews and admissions screening using established criteria. The role requires adept EMR review, strong clinical judgment, and collaboration with ED physicians...Remote job
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- ...seeking a Registered Nurse for a temporary Utilization Management role. You will ensure prior... ...care programs. Required are an active CA RN license and at least five years in patient... ...substitute for experience. Hybrid work and remote- interview options are offered. #J-188...Remote jobTemporary work
$41.72 - $105.65 per hour
...the healthcare team. Resolves patient problems and needs by utilizing multidisciplinary team strategies. Educates patients regarding... ...demand it. Additional Job Details (if applicable) Remote Type Remote Work Location 265 Charles Street Scheduled...Remote workHourly payDaily paidWork at officeShift work- Elevance Health is seeking a Wound Care Utilization Management RN for a virtual, full-time role. The position focuses on pre-certification and authorization for Home Health wound care services and coordinating care across providers. Hybrid work is available with some in...Remote jobFull time
- Molina Healthcare seeks an experienced RN to support Arizona Plan clinical member services... ...active AZ RN license and experience with utilization management, prior authorization, and both inpatient and outpatient settings. Remote position, must reside in Arizona, with...Remote job
- A healthcare recruitment firm is seeking a Lead Healthcare Recruiter (Utilization Management RN) for a remote 6-month contract. The ideal candidate will have an active RN license and experience with health plan operations. Responsibilities include evaluating healthcare...Remote jobContract work
$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 jobWeekend work- CVS Health is seeking a Utilization Management (UM) Nurse Consultant for a fully remote, full-time role open to CST zone candidates. You will coordinate, document, and communicate all aspects of utilization and benefit management, ensuring appropriate care levels within...Remote jobFull time
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- UnitedHealth Group is seeking an Utilization Management & Clinical Validation RN to accurately review medical records and extract case details, crafting defensible appeal letters using evidence-based literature and coding knowledge. You will work from anywhere in the U....Remote jobFlexible hours
- SSM Health is seeking a Manager of RN Utilization Management to oversee system-wide UM activities and lead a high-performing team. The role blends... ...across the continuum of care. The position is fully remote with a preference for candidates in MO, IL, WI, or OK, and...Remote jobWeekend work
- ...clinical review of all applicable patients as stated in system utilization management plan. Oversees Clinical Review Specialist as indicated.... ...Orientation is needed 3-4 days for first week. This role will be remote BUT regular meetings/trainings require being onsite at the...Remote workReliefWeekend work3 days per week
- A leading healthcare organization is seeking a Care Manager RN for a remote role primarily serving the state of Washington. This per diem position involves crucial utilization management activities, ensuring compliance with payer requirements and regulations. Candidates...Remote jobHourly payDaily paidDay shift
$75.3k - $135.4k
...Corporation is seeking a Clinical Supervisor to oversee the utilization management team ensuring appropriate care for members. The ideal candidate... ...years of experience in a related field, along with an active RN license in California. This position offers a salary range...Remote job- CorVel Corporation is looking for a Utilization Review Supervisor RN to direct operations in Rancho Cucamonga. The role includes managing day-to-day operations, ensuring quality service, and handling HR matters. This remote position requires strong communication skills,...Remote job
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- Centene Corp. is seeking a Supervisor, Utilization Management (RN) to lead and supervise our Clinical Review team. This role focuses on ensuring appropriate care for our members and promotes adherence to compliance standards through effective team management and continuous...Remote jobFlexible hours
- Humana, Inc. seeks a Manager for Utilization Management Nursing. This role coordinates medical services and benefit determinations, applying advanced... ...initiatives across the department. Requires an active RN license with eNLC, 2+ years of leadership and clinical experience...Remote job
- ...Healthcare Alliance is seeking a Nurse Manager for Utilization Management to supervise daily UM operations... ...and reporting. Requirements include RN license, 3+ years in healthcare, and 3+... ...leadership with UR/case management. Remote work options with occasional travel and...Remote jobContract work
- Ampcus Inc. is seeking a Utilization Management Specialist (Remote) to review medical necessity and authorization for clinical services. The role emphasizes clinical nursing expertise, care management experience, and adherence to guidelines and policies. The position requires...Remote job
$75.3k - $135.4k
...professional on our Medical Management/Health Services team. Centene... ...Supervises day-to-day activities of utilization management team.... ...principles preferred. RN - Registered Nurse - State Licensure... ...flexible approach to work with remote, hybrid, field or office work...Remote workFull timePart timeWork at officeFlexible hours- Ensemble is seeking Virtual Utilization Review Specialists to join our remote team. You will evaluate medical necessity... ..., and collaborate with care management and financial clearance teams to ensure... ...resources. Must hold an unrestricted RN or LPN license and have 3+ years...Remote job
- 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. You...Remote jobFull time
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