Remote Clinical Review Nurse - Utilization Management
Spectraforce Technologies Inc
Spectraforce Technologies, Inc. is seeking a Clinical Review Nurse for remote concurrent review responsibilities. The role assesses member health status, medical necessity, and appropriate care levels, contributing to discharge planning within care policies and guidelines.
Ideal candidates have 2–4 years of related experience (2+ years acute care UM or managed care preferred), nursing licensure, and a nursing degree. Remote work with EST preferred; CST considered.
#J-18808-LjbffrVacancy posted 2 days ago
Similar jobs that could be interesting for youBased on the Remote Clinical Review Nurse - Utilization Management in United States vacancy
- ...Description Job Description: Manager of Clinical Utilization Management - Denial... ...Position Type: Hybrid (85% remote, 15% onsite in Northridge,... ...daily tasks, performance reviews, and any necessary disciplinary... ...an accredited Registered Nursing Program; RN preferred....Remote workPermanent employmentFull timeTemporary workFlexible hours
- ...A peer review organization is seeking a full-time remote Utilization Management Physician Reviewer. Ideal candidates must hold an MD, DO, or DPM degree with active board... ...with management and providing guidance on clinical questions. This is a unique opportunity to work...Remote workFull timeWork from home
ExamWorks
United States3 days ago - ...TEKsystems is seeking a Clinical Quality Assurance Nurse / Utilization Review Nurse for a fully remote contract-to-hire role. The position involves ensuring quality and regulatory compliance for case reports and supporting the QA department. Responsibilities include...Remote workContract work
TEKsystems
United States4 days ago - ...Integrated Management Strategies, LLC is seeking an experienced Sr Review Coordinator for our healthcare consulting... ...practice. This fully remote role within the United States focuses on utilization review of plans of... ...programs, supporting non-clinical reviewers, and ensuring...Remote workWork from home
Integrated Management Strategies, LLC
United States4 days ago $34 - $35 per hour
Utilization Management - Clinical Nurse - Work from Home! Utilization Management - Clinical Nurse - Work from Home... ...Conducts telephonic and concurrent review of hospitalizations and extended... ...Clinical Review Nurse- Prior Authorization Remote Registered Nurse (Remote Patient...Remote workFull timeWork at officeWork from homeNight shift- Centene is seeking a Clinical Review Nurse for a remote role supporting members in Pennsylvania. The candidate will perform concurrent reviews... ...contribute to discharge planning, leveraging case management or utilization management experience. The position offers day-shift...Remote jobFull timeShift workDay shift
- ...CVS Health is hiring for an Utilization Management Nurse Consultant (RN) for remote work. The role focuses on concurrent review and ensuring timely, cost-effective care through evidence-based decision-making. Candidates need active RN licensure, multi-state capability...Remote work
4004 Aetna Medicaid Administrators
United States5 days ago $27.02 - $48.55 per hour
...Performs concurrent reviews, including... ...records in health management systems according to utilization management policies... ...necessity based on clinical policies and guidelines... ...Details This is a remote position. The required... ...Accredited School of Nursing or Bachelor’s degree...Remote workHourly payFull timePart timeWork at officeMonday to FridayFlexible hours$88.85k
...Select how often (in days) to receive an alert: Utilization Management Clinical Quality Nurse Reviewer RN II Job Category: Clinical Location: ID, US Position Type: Full Time Requisition ID: 13392 Salary Range: $88,854.00(Min.) -$115,509.00(Mid.) -$142...Full timeLACare Inc
Los Angeles, CA3 days ago$47.37 per hour
...Lancesoft is seeking a Care Review Clinician for a remote 3-month assignment. You will work with the Utilization Management team to review inpatient cases, authorize care, and ensure... ...RN/LPN/LVN license and 2–4 years of clinical experience. Strong InterQual knowledge, problem...Remote workHourly payLanceSoft
United States3 days ago- ...Hanker Systems Inc. is seeking a skilled Registered Nurse for Utilization Management/Utilization Review in a 100% remote role. California licensure is required, with 3+ years in acute hospital care management and recent utilization review experience. Epic proficiency...Remote work
Hanker Systems Inc.
Sacramento, CA2 days ago - ...-Authorization Registered Nurse for a remote, full-time role based in Virginia. The RN will review prior authorization requests... ...and educate providers on utilization and management processes. Requirements... ...least two years of varied clinical nursing experience in...Remote workFull time
Humana
United States11 hours ago - ...Sentara Health Plans is hiring a Clinical Claims Reviewer/RN for a remote role. This full-time position involves utilization management and post-payment review across various care settings, with RN licensure and coding credentials under consideration. The role offers...Remote workFull time
Sentara Health
United States2 days ago - ...seeking a skilled RN to provide clinical review and escalation support for Utilization Management activities. You will triage... ...necessity, and collaborate with Nurse Reviewers, medical directors, and... ...guidelines. The role offers a remote work option with occasional...Remote work
massgeneralbrigham
United States2 days ago - ...Cleveland Clinic is seeking an Utilization Management RN Reviewer to support remote operations from home. The role covers admission and concurrent reviews, and ensures medical necessity criteria are applied to hospital stays and discharges. Qualifications include RN...Remote work
Cleveland Clinic
New York, NY2 days ago - ...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....Remote workFull time
University of Miami
United States5 days ago - ...American Traveler is hiring a remote RN for Utilization Management requiring an active MA RN license and prior utilization review and managed care experience. The role centers on fully remote utilization management with schedules Monday–Friday, 8am–5pm, plus rotating...Remote workLocal areaMonday to FridayRotating shift
American Traveler
United States3 days ago - ...CVS Health is seeking an Utilization Management Nurse Consultant (RN) to review authorization requests across multiple medical specialties... ...evaluate medical necessity, and apply clinical criteria to support determinations. This remote role collaborates with providers and...Remote work
CVS Health
United States4 days ago - ...United States seeks a Registered Nurse for Utilization Management and Quality Review oversight. The role requires 5+ years... ...and travel as needed. This is a remote, nationwide position with... ...successful candidate will support clinical review activities, ensure compliance...Remote work
Health Care Service Corporation
United States4 days ago $52 - $56 per hour
...Advantage, Medicaid and MLTC). You'll own clinical grievances and appeals from intake... ...necessity judgment you built in utilization management. 100% remote (U.S.) | Contract | $52–$56/hr... ...end: intake, investigation, clinical review, decision and notification Apply...Remote workContract workAfternoon shiftPhaxis
United States4 days ago$35 - $40 per hour
...Sagility LLC, a leader in healthcare transformation, seeks an RN Utilization Management Reviewer for a fully remote role. You will perform timely clinical decision reviews for services requiring prior authorization across various clinical areas, applying criteria like...Remote workHourly paySagility LLC
United States3 days ago- ...Guidehealth is seeking a Utilization Management Registered Nurse (RN) for a fully remote, full-time position. The role involves... ...medical necessity criteria to reviews, documenting findings, and interfacing... ...license active and 3+ years clinical experience preferred....Remote workFull time
Guidehealth
United States4 days ago - ...'s Health Care System is seeking a Registered Nurse Utilization Management/Episodic Case Manager (UM/ECM - RN) Reviewer to coordinate the efficient utilization of health... ...Manager and Team Lead, you will assess clinical information, determine medical necessity with...Remote work
Cook Children's Health Care System
Fort Worth, TX16 hours ago - ...Sentara Health Plans is seeking an RN Clinician for remote utilization management and claims review. You will perform pre/post payment reviews, authorizations... .... Requires a BSN and 3 years of acute care clinical experience; CPC preferred. Remote options available across...Remote work
Sentara Health Plans
United States2 days ago - ...CorVel is seeking a Utilization Review Case Manager to gather demographic and clinical data for in-patient and outpatient reviews, certify medical necessity, and assign... ...the Case Management department’s goals. This remote role requires RN licensure and 4+ years of clinical...Remote work
CorVel Brand
Folsom, CA15 hours ago - ...OU Health is seeking a Case Manager, RN - Utilization Review (PRN) to evaluate medical necessity and appropriate care, securing authorizations and coordinating with payors, patients, and interdisciplinary teams. This role emphasizes HIPAA compliance and strong communication...Remote workRelief
OU Health
United States5 days ago - Alignment Health is seeking an inpatient review nurse to join our remote utilization management team. You will assess inpatients and collaborate with physicians, case managers and facilities to ensure the most appropriate, cost-effective care level. Qualified candidates...Remote job
- Alignment Health is seeking an inpatient review nurse to join our remote utilization management team. You will collaborate with the patient’s physician, facility case manager, discharge planner and contracted providers to ensure appropriate, cost-effective care at the...Remote job
- Alignment Health is seeking an inpatient review nurse to join the remote utilization management team. You will guide patients through the continuum of care, coordinating with physicians, case managers and service providers to ensure safe, cost-effective care aligned with...Remote job
- ...Integra Partners seeks an experienced Utilization Management Nurse Supervisor to lead the UM nursing... ...conduct regular 1:1s, manage performance reviews, and drive compliance with CMS, NCQA,... ...assignments and authorizations in a remote, nationwide work environment. #J-18...Remote work
NurseRemotely
United States3 days ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Clinical Review Nurse - Utilization Management. Be the first to apply!
Related searches
- clinical nurse United States
- nurse practitioner np United States
- geriatric medicine nurse practitioner United States
- neurology nurse practitioner United States
- adult geriatric nurse practitioner United States
- spine nurse practitioner United States
- infusion nurse manager United States
- nurse practitioner - telehealth United States
- clinical nurse coordinator United States
- assistant nurse manager United States