Remote Utilization Management Nurse (RN)
Cambia Health Solutions, Inc.
- 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 and promote cost-effective care. The candidate will collaborate across disciplines, maintain documentation, and respond to inquiries while upholding privacy and compliance standards. #J-18808-Ljbffr Cambia Health Solutions, Inc.
$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 home$60.2k - $107.4k
Optum is a global health services company focused on improving health outcomes through innovative care and technology. The Utilization Management Nurse will review patient records and craft defensible appeal letters per guidelines while adhering to HIPAA and company...Remote jobFull timeMonday to Friday$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- UnitedHealth Group's Optum unit seeks a Utilization Management Nurse to review medical records and craft defensible appeal letters with attention to... ...in the U.S. and a competitive benefits package. Requires RN license, associate degree, and 3+ years bedside nursing in...Remote jobMonday to Friday
- ...Job Summary: As an on-site Hospital Utilization Management (UM) Nurse, you are the primary link between the... ...administrative compliance. Unlike remote roles, this position relies heavily on... ...site UM Nurse is a Registered Nurse (RN) responsible for performing admission...Remote workImmediate startShift work
- ...CVS Health is seeking an experienced Utilization Management (UM) Nurse Consultant to join our remote team. This 100% work-from-home role serves members across the CST zone, ensuring safe, appropriate care and timely approvals. You will review clinical documents, collaborate...Remote workWork from home
- ...defined patient population. This includes utilization management, patient advocacy, and monitoring... ...procedures. It is expected that all RN Clinical Nurses are licensed, knowledgeable and... ...and administrative compliance. Unlike remote roles, this position relies heavily...Remote workImmediate startShift work
$72.8k - $130k
...scheduling and there is an occasional opportunity for remote work based on business needs. As a Sr Utilization Management Nurse in the Boston MA Regional Area, the role... ...Qualifications: ~ Registered Nurse (RN) with a current, active, unrestricted RN License...Remote workMinimum wageFull timeWork experience placementCasual workLive inWork at officeLocal area$68.89k - $92.14k
...Pay Plan Title: Utilization Management Nurse Working Title: Utilization Management Nurse – Physical Health... ...$68,890 - $92,138 Office Location: Remote within North Carolina. POSTING... ...Carolina Licensure as a Registered Nurse (RN). Must have a valid driver’s...Remote workWork at officeLocal areaImmediate startWork from homeFlexible hours- ...Humana is seeking a skilled Utilization Management Registered Nurse to interpret and coordinate medical services and benefit determinations for post-acute... ...in the right setting. The role requires a compact RN license, 1+ year of clinical RN experience, and a passion...Remote work
- ...Guidehealth is seeking an Utilization Management Registered Nurse to perform medical-necessity reviews and document findings... ..., and ensuring timely decisions in a remote work environment. Ideal candidates hold an active IL RN license, have 3+ years in healthcare settings...Remote work
- ...A healthcare staffing agency is seeking a Utilization Management RN to work remotely from PA, DE, or NJ. The role involves assessing clinical information, determining medical necessity for services, and collaborating with providers. Candidates should have at least three...Remote workFlexible hoursWeekend workDay shift
$60.15 - $85.81 per hour
...Job Summary: The Utilization Management Nurse supports the case management department by providing... ...coverage ~ Hybrid Position - Primarily remote/work-from-home, with an expectation to... ...Licenses and Certifications ~ RN - Registered Nurse License - CA-BRN -...Remote workFull timeWork experience placementWork from homeShift work- ...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 workContract work
- ...Akron Children’s Hospital is seeking a Utilization Management Nurse to perform medical necessity reviews and ensure proper use of hospital resources... ...and discharge planning. The position requires a BSN and RN licensure with at least 3 years of inpatient experience, including...Remote work
- ...in the United States is seeking an Inpatient Utilization Management Clinician to evaluate inpatient medical necessity... ...planning across care teams. This fully remote, full-time role requires an active RN license, nursing degree, and experience with InterQual guidelines...Remote workFull time
- ...TriWest Healthcare Alliance seeks a Utilization Management Clinical Review nurse to evaluate and authorize beneficiary care, focusing on cost-effective, appropriate utilization of Behavioral Health and Medical/Surgical services. Responsibilities include preauthorization...Remote work
- ...Seeking a full-time remote Utilization Management RN, the successful candidate will manage medical record reviews and denial documentation, develop... ...standards Required Qualifications Current, active Registered Nurse (RN) license 3+ years of bedside nursing experience in...Remote workFull time
- ...Utilization Management Registered Nurse (UM RN) We're seeking a dedicated and detail-oriented Utilization Management Registered Nurse (UM RN) to join our... ...regulations (LCD/NCD policies). This is a fully remote opportunity requiring discipline, accuracy, and effective...Remote work
- ...Utilization Review NurseAstrana Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services Department. In this position... ...Health Plans. This is a remote position for CA-licensed... ...of outpatient Utilization Management experience in a fast-paced...Remote workLive in
- ...California - Ability to work remote, but selected candidate must... ...requires California RN Licensure. Candidates must have... ...of the following functions: utilization management, care management, behavioral... ...(LTSS), behavioral health, nurse advice line, and/or other special...Remote workContract workWork at officeLocal area
- ...To support a centralized Utilization Management department, the full-time Utilization Review Nurse will conduct timely utilization review activities, ensuring appropriate... ...with regulatory requirements while working remotely. Key responsibilities: Conduct medical...Remote workFull time
- ...Full Time 40 hours/week remote Summary The Utilization Management Nurse is responsible for conducting medical necessity review to assure appropriate use of hospital resources and serving as a resource to the hospital staff on utilization management practices. Responsibilities...Remote workFull time
$71.1k - $97.8k
...About This Role The Utilization Management Nurse utilizes clinical nursing skills to support the coordination... ...: $71,100 - $97,800/year Location : Remote, LA Department/Unit : Care Management... ...to six weeks. Requirements Education: RN License in the state of Louisiana...Remote workFull timeTemporary workMonday to Friday- ...Utilization Management RN (Part-Time, Remote) Position Overview Under the direction of a designated manager, the Utilization Management RN... ...Discharge Planning Case Management Inpatient Acute Care Nursing Care Coordination Telephonic Clinical Review...Remote workPart timeMonday to Friday
- ...Find your calling at Mercy! Overview Utilization Management for the assigned inpatient Care Management population. This position is designed... ...Education: Graduate of an accredited school of nursing. Licensure: Current license in the state of residence and...Remote workRelief
- A global talent management firm is seeking a Utilization Review Nurse for a contract role based in Pennington, NJ. The role involves performing utilization management... ...discharge planning. Candidates must have an active RN license in New Jersey, strong analytical skills, and...Remote workContract work
- Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination of medical services and benefit determinations. You will work remotely, reporting to the Manager of Utilization Management, serving a post-acute care team including SNF, Home...Remote job
- A healthcare management organization is seeking a Utilization Management Nurse to oversee health service utilization while collaborating... ...role requires an active LPN/RN license, and candidates should... ...comprehensive benefits package including remote work options. #J-18808-Ljbffr...Remote job
$26.01 - $56.14 per hour
...something bigger - helping to simplify health care one person, one family and one community at a time. Registered Nurse (RN) - Utilization Management Remote | Work from Home | Central Time Zone Preferred Are you an experienced Registered Nurse looking to expand your...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeAfternoon shift
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