In-Home Utilization Review RN — Home Health
Integrated Home Care Services, Inc.
CLINICAL REVIEWER RN job at Integrated Home Care Services, Inc.. Hollywood, FL. Job Details Description Who we are: IHCS provides an Integrated Delivery System in the home setting, which includes, DME, Respiratory, Home Health and Home Infusion services. IHCS has a select network of Medicare and/or Medicaid Certified and Accredited providers to respond to the needs of our patients – 24/7. We operate with the sole intent of providing the highest quality in-home care services that improve and enhance the daily living for our patients, where our patients are #1 With over 30 years of experience, we are the trusted market leader in Home Health, Durable Medical Equipment, and Home Infusion Services. If you are passionate about inspiring, motivating, and leading teams this opportunity could be for you and we want to hear from you! Join our team as we strive for excellence through teamwork. We are committed to delivering high quality care to our patients through Exceptional Customer Service, Proven Outcomes, and Seamless Care. Full time team members competitive compensation package, include but not limited to; Medical, Vision, Dental, Short- and Long-term insurance 6+ Days of Holidays Pay 10+ days of PTO Employer paid life insurance 401K with employer contribution Wellness program with reward incentives Employee recognition and reward programs Comprehensive paid training program What Will You Be Doing As a Utilization Management Nurse, you will ensure that home health care services are administered with quality, cost efficiency, and within compliance. By continuously reviewing and auditing patient treatment files, the utilization nurse will ensure that patients won’t receive unnecessary procedures, ineffective treatment, or unnecessarily extensive home healthcare. Concurrent review of patient’s clinical information for efficiency Ongoing review of precertification requests for medical necessity Coordinates patient care needs with a multi-disciplinary healthcare team Maintain accurate records of all patient related interactions Ability to stay organized and interact well with others in any situation Provide updates to Manager of Utilization Management for review What Will You Come With State licensure as a LPN or RN Minimum 2 years of prior experience in Utilization Management Strong knowledge of word processing and spreadsheet computer programs Utilization Management or Case Management certification preferred Join our team as we strive for excellence through teamwork, where our patients are #1! IHCS is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. #J-18808-Ljbffr Integrated Home Care Services, Inc.
- ...CVS Health Corporation is seeking an RN Concurrent Review Nurse to join a remote team delivering inpatient clinical expertise... .... This role offers work-from-home scheduling, Monday–Friday, with... ...inpatient nursing, and 2+ years in utilization management or discharge planning,...Work from homeRemote workMonday to FridayWeekend work
- ...is seeking a skilled Medical Reviewer to evaluate a variety of medical... ...must hold an active RN license in the United States and... ...The role includes working from home within a defined US radius and... ...BSN and additional clinical and utilization review experience, plus proficiency...Work from homeRemote job
$65k - $85k
Utilization Review Specialist (RN) - Work From Home (Florida-Based Candidates Only) Concierge Home Care | Work From Home Opportunity - Must Reside in Florida... ...Review Specialist (RN) to join our remote home health team. This role is ideal for an RN with strong OASIS...Work from homeRemote workMonday to FridayShift workWeekend workWeekday work- Leave Your Mark is seeking a Registered Nurse for Utilization Review to support a Michigan health plan client from a home-based setting. The role focuses on prospective, concurrent, and retrospective reviews to determine medical necessity, level of care, and length of stay...Work from homeRemote job
- ...Sedgwick is seeking a Telecommuter RN for Utilization Review in the United States. The role requires an active RN license, an associate degree (bachelor’s preferred), and 4 years of related experience with utilization review. Certification is a plus. The position offers...SuggestedRemote work
- ...seeking a Registered Nurse for Utilization Management in a remote-... ...role. This position focuses on reviewing admissions and service requests... ...organization. The role requires Texas RN licensure and a nursing... ...including comprehensive health coverage, retirement plans, PTO...Remote work
$69.39k - $88.61k
...Cincinnati Children’s is seeking an experienced Utilization Review professional for a remote role in the United States. The position supports... ...role requires a Bachelor’s degree in a related field, an active RN/Social Work/Clinical Counselor license, and 2+ years of related...Full timeRemote work- ...Cincinnati Children e s Hospital Medical Center is seeking a Remote Utilization Review professional to perform admission and continued stay reviews using InterQual, ensuring medical necessity and appropriate level of care.The role collaborates with Admitting, Financial...Remote work
- Centene Corporation is seeking a fully remote RN appeals reviewer to support processing of medical necessity reviews for appeals. You will... ...license preferred), a BSN or CCM, and 2+ years in acute care, utilization management, or appeals. Familiarity with MCG/InterQual...Remote job
- Broadway Ventures is seeking a Medical Reviewer for a remote role handling various claims (... .... Minimum requirements include an active RN license in the U.S., an Associate’s degree, and 2+ years in clinical work with utilization/medical review. #J-18808-Ljbffr BROADWAY...Remote job
- ...A healthcare staffing firm is seeking a skilled Utilization Review RN to join their team. This fully remote position requires a valid PA RN license and prior experience in insurance utilization review. Responsibilities include conducting clinical reviews, applying evidence...Remote work
- ...Community Health Network (CHN) has been placing experienced nurses and therapists in home care, hospice, and case management for over 30 years. We offer... ...ours with a need for an experienced RN Case Manager with Utilization Review/UM experience. This position is remote...Contract workRemote workMonday to FridayFlexible hours
- BlueCross and BlueShield of South Carolina seeks an RN Medical Reviewer II to join the Palmetto GBA Medical Review team. You will perform medical... ...staff while supporting quality goals. This is a work-from-home, full-time role with daytime hours. #J-18808-Ljbffr BlueCross...Work from homeRemote jobFull time
$2,755 per week
...Solutions is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Bozeman,... ...industry, connecting nurses and allied health clinicians with hospitals and healthcare... ...a great place to work and a career home. We’ve received Best Places to Work...Work from homeWeekly payDaily paidShift work- Jobgether, on behalf of a partner company, seeks an experienced Case Manager - Utilization Review Specialist to oversee admission and concurrent reviews remotely in the United States. You will evaluate medical records for medical necessity, coordinate appeals, and collaborate...Remote job
- WNS HealthHelp (A Capgemini Company) is seeking a licensed registered nurse to perform concurrent inpatient utilization reviews from a remote setting. You will collaborate with attending physicians and care teams to determine medical necessity and appropriate level of care...Remote job
- HonorHealth is seeking an RN Utilization Review Specialist to review and monitor health care service utilization, ensuring appropriate levels of care and medical necessity across admissions and payer types. You will coordinate medical necessity reviews for Medicare, AHCCCS...Remote jobDaily paid
- ...Oklahoma City) full time days and every other weekend RN Case Manager -Utilization Review at INTEGRIS Health, Oklahoma City, OK. Get to Know Your Team: INTEGRIS... ...: 2 years experience in a clinical settings (e,g. home health, inpatient, physician office, clinic) LICENSE...Full timeWork at officeRemote workWeekend work
$1,949.74 per month
...Details Client Name Providence Health and Services Job Type Travel... ...Registered Nurse Specialty Utilization Review Job ID 17979666 Job Title Utilization Review RN Weekly Pay $1949.74 Shift...Weekly payRemote workShift work- Jobgether is partnering with a U.S.-based healthcare employer to recruit a Case Manager - Utilization Review Specialist for a fully remote role in the United States. The position focuses on admission and concurrent reviews, medical necessity determinations, and coordination...Remote job
- ...One of the largest health benefits companies in the United States.... ...specific to the LTSS department. RN will be responsible for... ...authorization and concurrent review. Provides monthly telephonic outreach... ...of treatment setting by utilizing the applicable medical policy...Contract workRemote workMonday to FridayFlexible hours
- Sedgwick is seeking a remote RN Utilization Review professional in Tennessee to provide timely utilization reviews and advocate for cost-effective patient care. You will assess medical conditions, coordinate with clinicians, and support evidence-based treatment decisions...Remote jobFlexible hours
- Quorum Health Corporate is seeking a remote Utilization Review Specialist with a registered nurse background to manage admission decisions and concurrent reviews, ensuring compliance with payer and regulatory standards. Responsibilities include coordinating appeals, documenting...Remote job
- Intermountain Healthcare Inc. is seeking an RN Utilization Review Care Management I for a fully remote, part-time role. You will review records, apply clinical guidelines, and collaborate with providers and members to ensure appropriate, cost-effective care across multiple...Remote jobPart timeWeekend work
- Intermountain Health’s St. Marys Regional Hospital seeks an RN Utilization Review Care Management I to perform utilization review screenings, assessments, and evaluations, focusing on cost-effective, high-quality care. The role involves collaboration with patients, families...Remote jobShift work
- iMPROve Health is recruiting a Michigan-licensed Registered Nurse (RN) for a contingent, fully remote Utilization Review / LTSS Review Nurse role. The position supports Michigan Medicaid programs... ..., reviews Nursing Facility LOC and Home Help assessments, and requires UR/UM...Remote jobFlexible hoursAfternoon shift
- Jobgether is partnering with a healthcare organization to hire a Case Manager - Utilization Review Specialist for a full-time remote role based in the United States. You will oversee admission and concurrent reviews, assess medical necessity, and coordinate appeals to...Remote jobFull time
- Jobgether, in partnership with a healthcare organization, seeks an experienced Case Manager - Utilization Review Specialist for a fully remote role in the United States. This position focuses on admission and concurrent reviews, medical necessity assessment, and coordination...Remote job
$65 per hour
...Fully Remote Position Job Title : RN - UTILIZATION REVIEW Location: Everett, WA 98201 Start Date: 05/04/2026 Duration: 13 weeks Schedule Shift: Day 5x8-Hour (08:00 - 16:30) Shift Notes: Days (5×8) | 08:00 - 16:30PAY DETAILS (72 HOURS / 2 WEEKS) Pay...Local areaImmediate startRemote workMonday to FridayShift workWeekend work- Saint Joseph Health System is seeking an RN Utilization Review specialist for a part-time, remote PRN role that requires on-site training in Mishawaka, Indiana. The position emphasizes reviewing medical necessity, insurance requirements, and discharge planning in collaboration...Remote jobPart timeRelief
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