Remote Utilization Management Nurse — PACE Care & Compliance
Santa Barbara Cottage Hospital
- Remote job
IntusCare is seeking a Utilization Management Nurse to ensure high-quality, cost-effective, and compliant care for PACE participants. You will review service utilization, guide care decisions, and support transitions across care settings, collaborating with Interdisciplinary Teams and Medical Directors. The role blends clinical expertise with analytical thinking to ensure services are medically necessary and aligned with care plans and PACE regulations. This is a fully remote US-based position. #J-18808-Ljbffr Santa Barbara Cottage Hospital
- ...Health is seeking a Utilization Management Nurse to oversee and manage... ...quality, cost-effective care for plan participants... ...to ensure compliance with CMS, URAC, and other... ...regulators. This fully remote role requires a US-based... ...ability to work in a fast-paced environment #J-18808...Remote job
$42 per hour
IntusCare is seeking a Contract Utilization Management Nurse to ensure high-quality, cost-effective, and compliant care for PACE participants. The role collaborates with interdisciplinary... ...care settings. The position is fully remote within the United States and offers a 1-...Remote jobHourly payContract work- ...Description The utilization review and management (UM) component program... ...level of care, while supporting regulatory compliance and organizational... ...Qualifications ~ Registered nurse with active,... ...to work in fast paced environment.... ...an in-office, no remote work capability position...Remote workWork at office
$85k - $105.34k
...UTILIZATION REVIEW NURSE REMOTE Ability to travel on-site to 3... ...-driven Coordinated Care Organization (CCO) dedicated... ...The Utilization Management Nurse evaluates clinical... ...settings, ensuring compliance with Oregon Health Plan... ...the needs of a fast-paced and challenging...Remote workFull timeWork at officeLocal areaImmediate startMonday to Friday- 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 workHourly payDaily paidDay shift
- ...Cottage Hospital is seeking a licensed practical nurse to join BHPS Utilization Management as a remote reviewer of medical necessity and benefit determinations... ...and the ability to work independently in a fast-paced managed care environment. #J-18808-Ljbffr Santa Barbara...Remote job
- ...Corp. is seeking a Supervisor, Utilization Management (RN) to lead and supervise our... ...on ensuring appropriate care for our members and promotes adherence to compliance standards through effective team... .... Candidates should possess a nursing degree and a valid California...Remote jobFlexible hours
- ...Utilization Management Nurse Onsite in Dubuque, IA. Also accepting remote applicants. We are looking for a nurse just like you - a nurse that thrives in a fast-paced environment, enjoys making a difference for patients... ..., outpatient tests, care, etc. Review requests...Remote workFull timeWork at office
$42 per hour
...Programs of All-Inclusive Care for the Elderly (PACE) programs deliver... ..., population health, and utilization management. IntusCare empowers teams... ...Contract Utilization Management Nurse plays a critical role in... ...location : This is a fully remote role based in the United...Remote workContract work$83k - $99k
...team. We only hire people that care deeply about others, thrive... ...and Responsibilities The Utilization Management Nurse collaborates with external entities... ...self-directed Enjoys the pace and rhythm of a deadline-... ...$600 wellness reimbursement Remote work and continuing education...Remote workFull timeWork at officeFlexible hours$60k
...experienced in the managed care payor environment... ...and post-service utilization reviews and... ...ABILITIES The UM Nurse’s responsibilities... ...Director Maintain compliance with all... ...to work in a fast-paced environment Team... ...opportunities Remote Opportunities...Remote workFull timeTemporary workLocal area$84.56k - $126.84k
...Job Overview The Utilization Review RN participates... ...reviews, ensure compliance, and actively... ...Name: Utilization Management Job Status: part time... ...will be primarily remote but there may be occasions... ...the continuity of care in conjunction... ...of Science in Nursing (BSN) Experience:...Remote workTemporary workPart timeLive inImmediate startRelocationRelocation packageShift workWeekend workAfternoon shift- ...patient journey - from care navigation and management to payment... ...Opportunity: As a Utilization Management Nurse, you’ll oversee and... ...participants. Ensure compliance with regulatory... ...to work in a fast-paced, detailed, deadline... ...: This is a fully remote position, and we’ll...Remote workFull timeImmediate startMonday to FridayFlexible hours
$26.01 - $68.55 per hour
Utilization Management Nurse - Precertification RN Remote | Full-Time | Weekday Schedule Are you a clinically strong Registered... ...appropriate, high-quality care through the precertification process... ...a high-volume workload in a fast-paced environment WHAT YOU BRING - REQUIRED...Remote workHourly payFull timeTemporary workLocal areaWeekday work$26.01 - $56.14 per hour
...EST Location: 100% Remote (U.S. only) About Us... ...-accredited medical management organization founded... ..., cost-effective care management solutions... ...medical journeys. As a Utilization Management (UM) Nurse Consultant... ...expertise in a fast-paced, desk-based environment...Remote jobHourly payFull timeTemporary workLocal areaMonday to FridayFlexible hoursShift work- CVS Health is seeking an experienced Utilization Management Nurse Consultant for a 100% work-from-home role in the EST time zone. The position supports... ..., coordinating with providers, and ensuring timely care while meeting state and federal requirements. Strong documentation...Remote jobWork from home
- CVS Health is seeking an experienced Utilization Management Nurse Consultant for a 100% work-from-home, full-time position open to MST/PST residents... ...activities, ensuring timely, safe, and appropriate care for members. In this role you will review medical necessity...Remote jobFull timeWork from home
$70k - $75k
...Guidehealth leverages remotely-embedded... ...and a centralized Managed Service Organization... ...Description The Utilization Management Registered... ...activities in compliance with federal and state... ...Quality of care concerns Interfacing... ...with current nursing practice standards...Remote workBi-weekly payFull timeTemporary workFor contractorsLocal areaWork from home- ...Registered Nurse: Review and Evaluation Are... ...program integrity through compliance management. Here, you'll... ...safeguard the quality of care, and influence healthcare... ...Experience in utilization review, case management... ...vulnerable populations Remote work enjoy the...Remote jobWork from home
- ...Are you a registered nurse ready to take your career... ...integrity through compliance management. Here, you'll... ...safeguard the quality of care, and influence healthcare... ...Experience in utilization review, case management... ...vulnerable populations Remote work - enjoy the...Remote workFull timeTemporary workWork at officeWork from home
$1,600 - $1,800 per week
...Now Hiring: Registered Nurse – Utilization Management Location: Buckley AFB & Peterson AFB, Colorado... ...weekends, no holidays, no telehealth/remote work Minimum Qualifications... ...months RN experience in direct patient care • 12 consecutive months in Utilization...Remote workContract workImmediate startMonday to Friday- Netsmart is seeking a Registered Nurse with solid utilization management experience to perform ED utilization reviews... ...will bring 3+ years of acute care experience, knowledge of InterQual/MCG... ...and proven ability to adapt in a fast-paced environment while maintaining #J-18...Remote job
$71.1k - $97.8k
...Become a part of our caring community The Utilization Management Nurse 2 utilizes clinical nursing skills to support... ...information.Travel: While this is a remote position, occasional travel to... ...Humana to take affirmative action, in compliance with Section 503 of the...Remote workFull timeTemporary workApprenticeshipWork at officeLocal areaWork from homeHome officeMonday to FridayShift work- ...Colorado is seeking a Registered Nurse for a remote-capable role focused on utilization and case management. This fully remote opportunity... ...teams to balance quality care with cost efficiency. Expect strong... ...supervision, and a fast-paced environment. #J-18808-Ljbffr...Remote job
- 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,... ...utilization and benefit management, ensuring appropriate care levels within state and federal requirements and...Remote jobFull time
- CVS Health seeks a Utilization Management Nurse Consultant to support a 24/7 operation. In this role you will assess, plan, implement, coordinate,... ...coverage determinations. You will communicate with providers and care teams to facilitate treatment decisions. Required RN...Remote job
$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... ...requires an active RN license and 3+ years of Managed Care or Clinical experience. The successful candidate will...Remote jobWeekend work- ...Health Plan Solutions seeks an experienced Utilization Management Nurse (LPN) to perform medical necessity and benefit reviews remotely. You will work within UM processes, coordinate... ...Office, and 2+ years in UM within managed care. Prior experience in various reviews and...Remote jobWork at office
- Humana Inc. is seeking an Utilization Management Nurse 2 to support coordination, documentation, and communication of medical service determinations. This remote role involves interpreting criteria and policies to provide optimal treatment for members, with occasional travel...Remote job
- CVS Health is seeking an Utilization Management Nurse Consultant for 24/7 operations. This remote role supports coverage decisions by reviewing clinical information, collaborating with care teams, and guiding resources to improve outcomes for members across time zones....Remote job
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