Remote Utilization RN — Care Coordination Expert
TriHealth
- Remote job
TriHealth is seeking a Utilization Management Nurse for a remote, full-time role. The position focuses on evaluating medical necessity to ensure appropriate care levels and alignment with payer requirements. You will collaborate with physicians, care management, and payers to secure authorizations and support patient outcomes. Requirements include an Associate's Degree in Nursing, active RN license at hire, 3–4 years of clinical nursing experience, and the ability to obtain a BSN within 5 years. #J-18808-Ljbffr TriHealth
$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...Remote workWeekend work- CVS Health is seeking a dedicated RN Case Manager to support members through comprehensive community-based care. This full-time role focuses on coordinating care, evaluating needs, and collaborating... ...Medicare. The position offers remote work from home, a strong benefits package...Remote jobFull timeWork from home
- HealthEdge is seeking a Registered Nurse to coordinate utilization/benefit management for health plans in a remote US role. The candidate will review authorizations, coordinate care plans, and communicate with providers to ensure medical necessity and appropriate levels...Remote job
- ...a Case Manager to join the FEP Case Management Team. The role coordinates care, resources and services for members, delivering individualized... ...monitoring within a hybrid work model. Ideal candidates hold an RN license in NC or a compact state, with 3 years of clinical/...Remote jobFlexible hours
- CVS Health is seeking a Case Manager RN for a 100% remote position focused on NICU/high-risk maternity care. The role involves telephonic and in-person assessments, planning and coordinating care to meet medical and wellness goals, while navigating complex health and social...Remote job
- CVS Health is seeking an experienced RN to assess, plan, and coordinate healthcare services for members. You will apply clinical criteria... ...coverage and collaborate with providers to facilitate care and benefit utilization. Ideal candidates hold an Associate Degree in...Remote jobWeekend workAfternoon shift
- Mass Digital Health in Quincy, Massachusetts is seeking a Utilization Review Nurse to evaluate patients for admission appropriateness and coordinate care activities. This role demands collaboration with physicians, care managers, and extensive clinical knowledge to ensure...
- A leading staffing agency is looking for a Utilization Review Registered Nurse to work remotely with a major health insurance client. This role involves evaluating patient care cases and ensuring requested services align with medical necessity while adhering to confidentiality...Remote work
- Integra Partners is seeking an LPN/LVN with experience in the managed care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. You will collaborate with our Medical Director to ensure NCQA-compliant UM program operations...Remote job
$45 per hour
...Job Description Job Description Utilization Management Nurse Coordinator (RN or LVN) needed for a temp 6+ month, remote contract opportunity with Yoh’s managed care health plan client based out of Redding or Fairfield, CA. Anticipating to be temporary for at least...Remote workContract workTemporary workMonday to FridayWeekend work$85 per hour
...Requirements Must be eligible to work in Remote Fluent proficiency in English (... ...clinical/health field (MD, DO, RN, RD, NBHWC, etc.) Current... ...Why this role At $85/hr, this Utilization Review Nurse / Managed Care Expert position compensates Healthcare expertise...Remote workHourly payTemporary work- ...populations,safeguard the quality of care, and influence healthcare... ...Registered Nurse (RN) license Strong clinical background... ...medical records Experience in utilization review, case management,... ...for vulnerable populations Remote work - enjoy the convenience...Remote workFull timeTemporary workWork at officeWork from home
- Frederick Health Hospital, Inc. is seeking a skilled RN Care Manager to coordinate patient care across hospital and ambulatory settings. You will... ...continuum, with a focus on improving outcomes and resource utilization. #J-18808-Ljbffr Frederick Health Hospital, Inc.
- ...Humana is seeking an Utilization Management Registered Nurse to interpret and coordinate medical services and benefit determinations for post-acute care. You will work remotely, reporting to the Manager of Utilization... ...include an active RN license in your state and 1...Remote work
- ...Allegheny Health Network seeks an RN Utilization Review professional to obtain pre-certifications, coordinate authorizations and manage denials for a seamless patient care continuum. You will liaise with... ...and timely approvals. This remote role requires PA RN licensure (...Remote work
- ...populations,safeguard the quality of care, and influence healthcare... ...Registered Nurse (RN) license Strong clinical background... ...medical records Experience in utilization review, case management,... ...for vulnerable populations Remote work - enjoy the convenience...Remote workFull timeTemporary workWork at office
- ...recruitment firm is seeking a Lead Healthcare Recruiter (Utilization Management RN) for a remote 6-month contract. The ideal candidate will have an... ...include evaluating healthcare services and coordinating care for members. Join a dynamic team and make a meaningful...Remote workContract work
$63.1k - $94.65k
...Our partner is looking for a Utilization Review RN based in the United States.... .... In this part-time, remote role, you will apply your clinical... ...admissions, and ensure care aligns with established clinical... ..., and effective care coordination across a diverse patient population...Remote workTemporary workPart timeWork at officeWork from homeFlexible hoursShift workAfternoon shift- ...populations, safeguard the quality of care, and influence healthcare... ...Registered Nurse (RN) license Strong clinical background... ...medical records Experience in utilization review, case management,... ...for vulnerable populations Remote work enjoy the convenience and...Remote jobWork from home
$70k - $75k
...Utilization Management Registered Nurse (RN) - Remote ~ Full-time WHO IS GUIDEHEALTH? Guidehealthis a data... ...services Quality of care concerns Interfacingroutinely... ...reliable and user-friendly. Care Coordination & Quality Support Initiatingreferrals...Remote workBi-weekly payFull timeTemporary workFor contractorsLocal areaWork from home$55 - $65 per hour
...Adult Inpatient Nurses (RN) Type: Contract... ...5/hour Location: Remote Role Responsibilities... ...datasets . Provide expert feedback on nursing assessments... ...) Recent adult acute care inpatient bedside... ...quality improvement, utilization review, CDI, or clinical...Remote workContract workSummer work- ...Utilization Management RN (Part-Time, Remote) Position Overview Under the direction of a designated... ...recommends alternative levels of care when appropriate. This role supports... ...Inpatient Acute Care Nursing Care Coordination Telephonic Clinical Review...Remote workPart timeMonday to Friday
- ...Remote Utilization Review Specialist In this remote role, you will conduct utilization reviews, ensuring that patient care meets the necessary standards. You will coordinate with healthcare teams for optimal patient outcomes while managing documentation and compliance...Remote workWeekly pay
- ...seeking a Medicare Precertification Utilization Management Nurse Consultant (RN) to join our remote Utilization Management team.... ...on ensuring appropriate care coverage and optimizing member... ...clinical data, apply guidelines, coordinate with providers, and serve as a...Remote workFull timeWeekend work
- ...Description Job Description The utilization review and management (UM)... ...at the appropriate level of care, while supporting regulatory... ...necessity of treatments and coordinate care effectively # Data... ...This is an in-office, no remote work capability position Travel...Remote workWork at office
$80k - $120k
...Clinical Expert, Care Team Operations (RN) Remote Thesis is building the AI-powered care team platform for infinitely scalable clinical capacity.... ...our clinical operations team. This is a broad-scope "utility player" role for a clinician who is equally comfortable...Remote work$63.1k - $94.65k
...Registered Nurse to perform hospital utilization reviews, assess medical... ...appropriate levels of care. This remote role partners with physicians... ...business day of admission. Coordinate Level-of-Care Decisions:... ...Skills: Current unrestricted RN license required; RN compact...Remote workTemporary workWork at officeLocal areaShift workAfternoon shift$63k - $94k
...Remote Utilization Review Registered Nurse (UR RN) Are you an experienced RN looking to transition away from the bedside... ...a massive impact on patient care? We are seeking a dedicated Utilization... ...Denial Management & Appeals: Coordinate the Peer-to-Peer (P2P) process with...Remote workWork at office10 hours per weekFlexible hoursShift workWeekend workAfternoon shift3 days per week- ...Summary and Responsibilities As our Utilization Review RN, you will meticulously review medical... ...stakeholders—physicians, payers, and Care Coordinators—regarding review outcomes. Your... ...status. This position is open to remote/out of state candidates residing in only...Remote work
- HealthEdge is seeking a Telephonic Utilization Management RN to coordinate, document, and communicate all aspects of the utilization/benefit management... ...clinical needs, review authorization requests, and ensure care plans align with medical necessity across inpatient and...Remote job
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Utilization RN — Care Coordination Expert. Be the first to apply!



