Remote Lead RN, Utilization Management

Clover Health

Clover Health is seeking a Lead RN, Utilization Management, to coach UM nurses, oversee daily review operations, and monitor quality. You will partner with Medical Directors and Clover teams to strengthen review consistency and improve workflows while ensuring compliance with CMS guidelines. The role emphasizes leadership, clinical judgment, and member-first decision-making within a remote-friendly environment. #J-18808-Ljbffr

Apply

Vacancy posted 4 days ago

Similar jobs that could be interesting for youBased on the Remote Lead RN, Utilization Management in Salem, OR vacancy

Remote Utilization Management Supervisor (RN Lead)
...Centene is seeking an experienced Supervisor of Utilization Management to lead the Prior Authorization, Concurrent Review, and Retrospective Review teams. This remote role supports members across the health plan with a focus on quality and compliance. You will supervise...
Remote work
Centene Corporation
United States
1 day ago
Remote Lead Utilization Review RN
...Ensemble Health Partners is seeking a Lead Utilization Review RN to drive medical necessity reviews, discharge planning, and appeals coordination... ...supports revenue cycle integrity and patient care quality in a remote US-based environment. You will evaluate admissions,...
Remote work
Ensemble Health Partners
Columbus, OH
1 day ago
RN Team Lead (Remote)
$81.95k - $110.24k
...career at Ensemble! Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems,... ...in healthcare. The Lead Utilization Review RN is a key contributor to the... ...required #LI-LS1 #LI-REMOTE Join an award-winning company...
Remote work
Full time
Work at office
Local area
Ensemble Health Partners
Ohio
15 days ago
Lead Utilization Review, RN
$39.4 - $53 per hour
...career at Ensemble! Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems,... .... Position Overview The Lead Utilization Review RN is a key contributor to the... ...24 Monster Top Workplace for Remote Work 2024 Great Place to Work...
Remote work
Work at office
Local area
Ensemble Health Partners
Columbus, OH
11 hours ago
Hybrid RN Utilization Management Leader
...Cambia Health is seeking a Manager of Utilization Management to lead clinicians and staff across multiple plans.... ...role combines on-site leadership with remote collaboration to optimize prospective... ...with executives to align goals. A RN with clinical leadership and insurance...
Remote work
Relocation
Cambia Health
Vancouver, WA
3 days ago
Remote Utilization Management Manager - RN Leader
...Centene Corp. is seeking a Manager of Utilization Management to oversee Prior Authorization, Concurrent Review, Retrospective Review, and Appeals teams. This remote role requires a clinical leader with strong UM experience and Oklahoma residency. You will develop,...
Remote work
Centene Corporation
United States
2 days ago
Remote Monitoring RN, Team Lead
...patient population. This includes utilization management, patient advocacy, and... ...reimbursement accuracy.The Team Lead of On-site UM is responsible... ...procedures.It is expected that all RN Clinical Nurses are licensed,... ...compliance. Unlike remote roles, this position relies heavily...
Remote work
Full time
Immediate start
Shift work
Wellstar Health Systems, Inc.
Marietta, GA
more than 2 months ago
UM Team Lead RN- Onsite
...patient population. This includes utilization management, patient advocacy, and... ...reimbursement accuracy. The Team Lead of On-site UM is responsible... .... It is expected that all RN Clinical Nurses are licensed,... ...administrative compliance. Unlike remote roles, this position relies...
Remote work
Immediate start
Shift work
Wellstar Health Systems, Inc.
Marietta, GA
8 hours ago
Nurse Leader, Utilization Management - Physical Health
...Health Resources is seeking a Nurse Manager, Utilization Management – Physical Health to lead day-to-day utilization management... ...area. The role requires an RN with NC licensure and willingness to travel within the catchment; remote work options are available for many...
Remote work
Trillium Health Resources
New York, NY
5 days ago
Remote UM Lead & CDI Mentor (RN)
...Omega Healthcare Management Services Pvt. Ltd. is seeking a Clinical Utilization Management RN to lead review programs and collaborate with care teams in a remote home-office setting. The role requires strong knowledge of InterQual criteria, Medicare guidelines, and...
Remote work
Home office
Omega Healthcare Management Services Pvt. Ltd.
United States
3 days ago
UM/UR & CDI Lead (RN)
$97.76k - $104k
...Collaborate with physicians, case management, and hospital leadership to optimize utilization management, patient... ...This job operates in a remote home office environment.... ...Registered Nurse (RN) license. · 3-5 years... ...coordinating workflows, or leading process improvement. ·...
Remote work
Full time
Work at office
Home office
Monday to Friday
Weekend work
Omega Healthcare Solutions
Remote
8 days ago
Registered Nurse (RN) - Utilization Management - FT/Day - Augusta
...Job Summary: As an on-site Hospital Utilization Management (UM) Nurse, you are the primary link between... ...and administrative compliance. Unlike remote roles, this position relies heavily on... ...-site UM Nurse is a Registered Nurse (RN) responsible for performing admission...
Remote work
Full time
Immediate start
Shift work
Wellstar Health Systems, Inc.
Augusta, GA
20 days ago
Remote Enterprise BD Lead for Utility Grid Modernization
...Pitch Aeronautics Inc. is seeking a remote Business Development professional in the United States to drive new utility sector opportunities, manage pilots to production, and expand partnerships with channel partners. The role requires deep utility industry knowledge and...
Remote work
Pitch Aeronautics Inc.
New York, NY
2 days ago
RN Lactation Consultant Lead
$33.85 - $53.9 per hour
...preliminary diagnosis and therapeutic plan utilizing principles of prevention Recommends... ...(IBCLC) certification required. Current RN licensure in applicable state required. Refer... ...to travel between campus buildings, remote facilities, and out of town as needed: No...
Remote work
Hourly pay
Full time
Part time
Work experience placement
Relief
Local area
Shift work
UVA Health
Manassas, VA
3 days ago
Assistant Professor, Faculty Specialization Lead RN-BSN (Remote)
$82k - $85k
...00 per year Work Location: Remote - USA OVERALL PURPOSE OF... ...Professor, Faculty Specialization Lead for the RN-BSN is responsible for... ...strategic goals. Change Management – Develops workable implementation... ...thoroughness. Technology utilization in education – Demonstrates...
Remote work
Full time
Post University
Connecticut
6 days ago
Oracle Utilities Integration Lead
...Oracle practice (.)You Are:A senior Oracle Utilities Integration Lead who brings both the architectural... ...data mapping artifacts.Establish and manage integration testing strategy and execution... ..., including meter data exchange, remote connect/disconnect, and on-demand read...
Remote work
Work experience placement
Live in
Work at office
Local area
Accenture
Milwaukee, WI
4 days ago
Solar Commissioning Lead | Utility-Scale (Remote)
...Westinghouse Electric Company LLC is seeking a Utility-Scale Solar Commissioning Lead for a remote role with up to 20% travel to sites nationwide and to the... ...PV plant systems, coordinate startup readiness, and manage SCADA/AVR/AGC communications with stakeholders. Requires...
Remote work
Westinghouse Electric Company
Juno Beach, FL
3 days ago
Remote Behavioral Health Utilization Lead
...Banner Health in remote Arizona is seeking a Behavioral Health Utilization Care Manager to review prior authorization requests for outpatient behavioral health and ensure medical necessity. You will collaborate with providers and interdisciplinary teams, support timely...
Remote work
Banner Health
Arizona
9 hours ago
Remote RN - Utilization Management & Case Review
...Arkansas Blue Cross Blue Shield is seeking an experienced Utilization Management Nurse to perform clinical reviews for prior approvals, benefit inquiries, and inpatient/outpatient services. This role requires interpreting evidence-based criteria, guidelines, and policies...
Remote work
Work from home
Arkansas Blue Cross
United States
3 days ago
Supervisor, Care Management- RN-REMOTE
...Franciscan Alliance is seeking a Supervisor Utilization Management to lead the Centralized Utilization Management department. The role focuses on... ...with internal and external customers. This position is remote with up to 20% travel. The incumbent will supervise a team...
Remote work
Franciscan Alliance, Inc.
United States
2 days ago
Lead Utilization Management Pharmacist (Fully Remote)
...Lead Utilization Management Pharmacist overseeing daily clinical pharmacy functions. Ensure efficient processing of medication requests while... ...prior authorization. Ability to work independently in a remote, metric-driven environment. Work Requirements:...
Remote work
Shift work
Weekend work
Judi Health, LLC
United States
2 days ago
Remote RN Utilization Management Nurse
...Arkansas Blue Cross and Blue Shield is seeking an RN Utilization Management Nurse to perform clinical reviews for medical necessity across various services. The role involves weekend coverage and work from home within Arkansas and several western states. The ideal candidate...
Remote work
Work from home
Weekend work
Arkansas Blue Cross
New York, NY
5 days ago
Remote Utilization Management RN - Care Coordination
...Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of... ...receive appropriate care in the right setting. This remote role requires US RN licensure in the state of residence and at least one year...
Remote work
Work from home
Humana
United States
5 days ago
RN Lead Surgery (OR) - La Jolla Green
...RN Lead Surgery (OR) - La Jolla Green This is a Full time, benefited position as a Lead... ...flow, case progression, and room utilization. Supports implementation of new technologies... ...geographical pay differential may be applied for remote employees who reside out of state....
Remote work
Full time
Work at office
Relocation package
Shift work
Weekend work
Day shift
Scripps Health
La Jolla, CA
10 hours ago
Cardiac Device Clinic RN II - Remote Monitoring Lead
...leadership and coordination of device management activities to support high-... ...care across in-office and remote monitoring services. This... ...Friday. A minimum of 2 years RN work experience is required. Previous... ...and function of devices and utilizes critical thinking skills. Responsible...
Remote work
Full time
Temporary work
Part time
Work experience placement
Work at office
Monday to Friday
Geisinger Health System
Wilkes Barre, PA
3 days ago
Remote Lead Utilization Pharmacist - Prior Authorization
...Judi Health, LLC is seeking a Lead Utilization Management Pharmacist to oversee daily clinical pharmacy functions, including prior authorization... ...and a PharmD or BS in Pharmacy with 2+ years of experience. Remote work from the US with ET shift and weekend/holiday...
Remote work
Shift work
Weekend work
Judi Health, LLC
United States
5 days ago
Lead Utility Notification Technician
...Lead Utility Notification Technician Responsibilities Lead a team of Notifiers, providing... ...directly with tree owners, land managers, and other stakeholders to provide notifications... ...conditions, challenging terrain, and remote locations while prioritizing safety Willingness...
Remote work
Full time
Atlas Field Services
Dallas, TX
3 days ago
Lead Quality Control Utility Forester - Vegetation Management
...Lead Quality Control Utility Forester - Vegetation ManagementCurrently looking for candidates in the client... ..., tree-trimming, and vegetation management work performed by Work Planners to ensure... ...conditions (weather, terrain, remote/urban settings).Proficiency with technology...
Remote work
For contractors
Local area
Weekend work
Iapetus Holdings LLC
Stonewall, LA
1 day ago
RN Readmission Review Lead — Clinical Auditor
...applications for a Clinical Readmission Manager to lead inpatient readmission reviews... .... The role requires RN licensure, 5+ years in... ...Payment Integrity, quality, utilization management, and other teams to... ...compliant recordkeeping in a remote-capable #J-18808-Ljbffr Devoted
Remote work
Devoted
New York, NY
5 days ago
Lead Medical Director, Utilization Management (Fully Remote)
...Lead UM Medical Directors in making timely, evidence-based medical necessity decisions. Evaluate outpatient... ...appropriateness. Key Responsibilities: Manage a team, review complex cases, and chair the Utilization Management Committee. Partner with clinical and...
Remote work
Flexible hours
Clover Health
United States
3 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Remote Lead RN, Utilization Management. Be the first to apply!