Remote Utilization Management Nurse
Cambia Health Solutions
Pocatello, ID
- Remote job
Cambia Health Solutions seeks an Utilization Management Nurse to conduct reviews (prospective, concurrent, retrospective) and ensure medical necessity and policy compliance. You will consult with physician advisors and collaborate with interdisciplinary teams to improve transitions of care and patient outcomes. The role emphasizes applying evidence-based criteria, extensive documentation, and strong communication skills to support members, providers, and regulatory bodies. #J-18808-Ljbffr Cambia Health Solutions
Vacancy posted 2 days ago
Similar jobs that could be interesting for youBased on the Remote Utilization Management Nurse in Pocatello, ID vacancy
- ...Humana is seeking a Utilization Management Nurse to support coordination, documentation, and communication of medical services and benefit determinations... ...make critical patient-care decisions. This full-time, remote position offers a competitive salary and comprehensive...Remote workFull time
Humana
United States1 day ago - ...CVS Health is seeking a Utilization Management Nurse Consultant for a fully remote position. You will review medical necessity, facilitate discharge planning, and collaborate with providers to support members with complex needs. Qualifications include ADN required,...Remote work
CVS Health
United States3 days ago - ...Humana is seeking a Utilization Management Nurse to leverage clinical nursing skills in coordinating, documenting, and communicating medical service determinations. The role requires independent interpretation and decision making within established guidelines, with collaboration...Remote work
Humana
United States4 days ago - ...Utilization Management Nurse BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical... ...requirements, and a member's benefit coverage while working remotely. Primary Responsibilities: Performs clinical utilization...Remote workContract workWork at office
Brighton Health Plan Solutions
Chapel Hill, NC1 day ago $1,600 - $1,800 per week
...NOW HIRING: Registered Nurse - Utilization Management Location: Buckley AFB & Peterson AFB, Colorado Military Health System Compensation... ..., 0730-1630 No weekends, no holidays, no telehealth/remote work Minimum Qualifications ~ U.S. Citizenship...Remote workContract workImmediate startMonday to FridayVarite
Aurora, CO3 days ago- ...Utilization Management Registered Nurse (UM RN) We're seeking a dedicated and detail-oriented Utilization Management Registered Nurse (UM RN) to join... ...regulations (LCD/NCD policies). This is a fully remote opportunity requiring discipline, accuracy, and effective...Remote work
Appworks
United States3 days ago - ...Utilization Management Department (Fully Remote) Provides health care services regarding admissions, case management, discharge planning and utilization review. Reviews admissions and service requests within assigned unit for prospective, concurrent and retrospective...Remote work
3B Healthcare, Inc.
United States5 days ago - ...Cambia Health Solutions in Medford, OR is seeking an experienced Utilization Management Nurse to perform prospective, concurrent, and retrospective reviews ensuring medical necessity and adherence to policy. You will apply evidence-based criteria and collaborate with...Remote work
Cambia Health Solutions
Medford, OR1 day ago $70k - $75k
...Utilization Management Registered Nurse (RN) - Remote The Utilization Management Registered Nurse is responsible for performing utilization review activities in compliance with federal and state regulations, URAC standards, and Guidehealth policies. This role applies...Remote workBi-weekly payFull timeTemporary workFor contractorsLocal areaWork from homeGuidehealth
United States3 days ago- ...CVS Health is seeking an experienced Utilization Management Nurse Consultant to apply clinical judgment and guidelines to determine appropriate benefits across the continuum of care. This full-time role supports a 24/7 operation, with scheduled weekends, holidays and...Remote workFull timeWeekend workAfternoon shift
4062 Aetna Resources, LLC
United States4 days ago $29.1 - $62.32 per hour
...Utilization Management Nurse Consultant Clinical Precertification RN (Medicare- Complex Spine Team) We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded...Remote workHourly payFull timeTemporary workWork at officeWork from homeMonday to FridayAfternoon shiftCVS Corporation
United States5 days ago$36.8 - $49.8 per hour
...Utilization Management Nurse Work from home within Oregon, Washington, Idaho or Utah. Preference will be given to current employees and candidates who reside in Idaho and Utah. Build a career with purpose. Join our Cause to create a person-focused and economically...Remote workFull timeWork at officeImmediate startWork from homeFlexible hoursCambia Health Solutions
United States4 days ago- ...The Utilization Management (UM) Nurse is a licensed nursing professional responsible for reviewing UM cases and discharge planning activities. The... ...organizations, or patient's home which may be in understaffed/remote areas, in the presence of pets or family members that are...Remote workFull timeWork at office
North East Medical Services
Burlingame, CA2 days ago $32.01 - $68.55 per hour
## Utilization Management Nurse ConsultantApply: Remote: IL - Work from home: Work At Home-Ohio: Work At Home-Texas: Work At Home-Georgia: Work At Home-West Virginia: Full time: Posted Today: End Date: October 11, 2026 (4 days left to apply): R1047682We’re building a world...Remote workHourly payFull timeTemporary workWork at officeWork from homeMonday to FridayAfternoon shiftCVS Health
Eastern, KY4 days ago- Optum is seeking a Registered Nurse with managed care experience to evaluate outpatient services and determine appropriate care in a remote role within the United States. You will translate... ...-functional teams, and supporting utilization management and case management...Remote job
- Cambia Health Solutions, Inc. is seeking a Utilization Management Nurse to join our Clinical Services team. This remote role supports members in Oregon, Washington, Idaho or Utah, conducting prospective, concurrent and retrospective reviews to ensure medical necessity...Remote job
- Humana is seeking a skilled Utilization Management Registered Nurse to interpret and coordinate medical services and benefit determinations for post-acute care such as SNF, Home Health, and DME. You will report to the Manager of Utilization Management and collaborate with...Remote job
- CVS Health is seeking a Nurse Consultant for Utilization Management in a 100% remote role. You will apply clinical judgment and evidence-based criteria to review inpatient and outpatient services, collaborate with providers to authorize care, and elevate cases when needed...Remote job
- CVS Health is seeking an experienced Registered Nurse for a fully remote Utilization Management Nurse Consultant role. This position is ideal for individuals who thrive in a fast-paced environment and are looking to make a clinical impact without direct patient care. Highlights...Remote job
- CVS Health Corporation is seeking a Nurse Consultant to join our Utilization Management team. This remote role reviews inpatient and outpatient services using clinical judgment and evidence-based criteria, collaborates with providers, authorizes care, and elevates cases...Remote job
- CVS Health Corporation is seeking a Nurse Consultant to join our Utilization Management team. The role focuses on applying clinical judgment and evidence-based criteria to review inpatient and outpatient services, authorizing care, and escalating cases when needed. The...Remote job
- The Utilization Management Nurse supports the Case Management Department by performing a variety of utilization management functions to promote appropriate... ...rotating weekend coverage Hybrid Position - Primarily remote/work-from-home, with an expectation to be on-site at least...Remote workFull timeWork from homeShift 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 Corporation is seeking an experienced Registered Nurse to join our Utilization Management team in a fully remote precertification role. Preference is given to Virginia residents or candidates holding Virginia and Compact RN licenses. The position involves reviewing...Remote job
$60k
...LPN/LVN Utilization Management Nurse Integra is looking for a LPN/LVN experienced in the managed care payor environment to perform pre-service... ...wellness programs ~ Career development opportunities Remote Opportunities We are actively seeking new colleagues in...Remote workTemporary workLocal areaIntegra Partners
United States2 days ago- CVS Health is seeking an experienced Utilization Management Nurse Consultant (RN) to evaluate requests for authorization across medical specialties... ...-based review and collaboration with care teams in a remote setting. The position requires active multi-state RN licensure...Remote job
- Mass General Brigham Health Plan Holding Company, Inc. seeks a Nurse for utilization review to assess medical necessity and benefit coverage for ACO/HMO/EPO members. Remote with occasional on-site team meetings in Somerville, MA. Strong InterQual/Milliman experience and...Remote job
- Cambia Health Solutions is seeking a Utilization Management Nurse to join the Clinical Services team. You will perform prospective, concurrent, and... ..., and the ability to interpret policies. We offer remote work options in several western states, a competitive salary...Remote job
- CVS Health is hiring a Nurse Consultant for a 100% remote Utilization Management role. You will apply clinical judgment to review inpatient and outpatient services, authorize care, and collaborate with providers while maintaining precise documentation. The position requires...Remote jobFlexible hours
- CVS Health is seeking a remote Utilization Management Nurse Consultant (RN) to review authorization requests across medical specialties and determine medical necessity using evidence-based guidelines. The role emphasizes collaboration with providers and care teams to ensure...Remote job
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Utilization Management Nurse. Be the first to apply!
Related searches
- clinical data coordinator remote Pocatello, ID
- part time project manager remote Pocatello, ID
- web developer internship remote Pocatello, ID
- remote weekend Pocatello, ID
- remote travel jobs Pocatello, ID
- fully remote Pocatello, ID
- tax remote Pocatello, ID
- part time remote medical coder Pocatello, ID
- companies hiring remote Pocatello, ID
- part time remote tech Pocatello, ID