Remote RN Leader, Utilization Management
Centene Management Company LLC
- Remote job
Centene Management Company LLC is seeking a Clinical Supervisor to lead the Medical Management team. This fully remote position requires an active New York State Registered Nurse licensure and involves overseeing day-to-day activities of the utilization management team while ensuring compliance with quality and performance standards. You will play a key role in educating the team, monitoring clinical reviews, and championing process improvements within utilization management. #J-18808-Ljbffr Centene Management Company LLC
- ...Acentra Health, LLC is seeking a Clinical Supervisor – RN – Full-time to oversee Utilization Management activities. This remote position requires strong clinical and leadership skills to manage UM processes, improve care management, and ensure compliance with standards...Remote workFull time
- ...Dane Street, LLC is seeking a remote Physician Reviewer for full-time work from home. The role requires an MD or DO, board-certified in Internal or Family Medicine, to perform utilization reviews, including preauthorization and appeals. Ideal candidates will have prior...Remote workFull timeWork from home
$106k - $161k
...A leading utility services provider is seeking an experienced Utility Practice Leader for Technical Presales to drive transformation initiatives across the North American utility sector. You will advise clients, tailor solutions, and ensure delivery excellence in a client...Remote work- ...Truman Medical Centers is seeking a Utilization Management RN for a part-time position working from home. The role involves partnering with interdisciplinary teams to optimize patient care and resources, ensuring compliance with regulatory standards. Applicants should...Remote workPart timeWork from home
- ...Massachusetts RN Utilization Supervisor is a full-time remote position responsible for overseeing daily operations of Medicare Advantage utilization management staff, providing coaching and evaluation, and participating in organizational projects. Key Responsibilities...Remote workFull time
- ...technicians, scientists, planners, surveyors, and construction management professionals, this dynamic organization operates in more... ...True Environmental is currently seeking a Power & Utilities Market Leader for the Western United States. This is a strategic position...Remote workWork at officeLocal area
- ...A leading healthcare organization is seeking a Per Diem Medical Director to oversee Utilization Management. The role involves collaborating with physicians, enhancing care quality, and developing policies within a managed care environment. Candidates should have at least...Remote workHourly payDaily paid
$150k - $300k
Tetra Tech is seeking a Power and Utility Sales Leader for a remote/flexible position in the U.S. The role involves leading business development activities to win clients and projects in the power sector, focusing on solution selling and building relationships. Candidates...Remote jobFlexible hours- ...Job Description Spectrum Healthcare Resources has a potential need for Registered Nurse Utilization Managers (RNUM) . These will be completely remote positions, working entirely from the Nurse's home. The Nurse will be reviewing cases, educating patients on appropriate...Remote workFull timeContract workWork at officeWork from homeMonday to Friday
- ...healthcare provider in California is seeking a Supervisor of Utilization Management to oversee operations of the Pre-Authorization team. This role... ...referrals, and facilitate team meetings. A California RN license is required. This position offers a hybrid work environment...Remote job
- ...Appworkshub is seeking a dedicated and detail-oriented Utilization Management Registered Nurse (UM RN) to join our remote healthcare team. In this role, you will conduct inpatient and outpatient utilization reviews, support transitions of care, and ensure compliance with...Remote work
- ...The Peer-to-Peer (P2P) Utilization Review Nurse is an integral member... ...the MGB Central Utilization Management team, specializing in identifying... ...(CONI) processes through RN-to-RN collaboration with payers... ...Schedule and Work Model ~ Remote / Work from Home. ~32...Remote workWork from home
$110 - $130 per hour
...A healthcare staffing company is seeking a Medical Director to lead utilization management and quality improvement for Medicare inpatient care. This remote role requires board-certified physicians with active medical licenses in FL and TX. Key responsibilities include...Remote work$34.98 - $42.85 per hour
...Clever Care is hiring a UM Nurse I - RN to conduct clinical reviews of authorization requests in California. The role... ...minimum of three years of clinical experience, preferably in utilization management. This remote position offers a wage range of $34.98 to $42.85 per hour...Remote workHourly pay- ...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
- ...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
- ...Phoebe Putney Memorial Hospital, Inc. is seeking a full-time RN UR Specialist in Albany, GA. Responsibilities include managing insurance notifications and certifications for Utilization Review, ensuring compliance with regulations while supporting patient care. Candidates...Remote workFull time
- ...A healthcare staffing agency seeks a Utilization Management RN to evaluate clinical conditions through medical record reviews. The position is remote, requiring candidates to reside in PA, DE, or NJ. Key duties involve applying criteria for medical necessity, collaborating...Remote work
- ...Clover Health is seeking a Remote Utilization Management Registered Nurse (RN) to support members throughout their care journey. This role involves performing medical necessity reviews, applying CMS guidelines, and collaborating with providers to ensure high-quality care...Remote work
- A healthcare institution in Addison, TX seeks an experienced Registered Nurse (RN) to oversee the Case Management team focusing on Utilization Review. Responsibilities include managing departmental operations, ensuring compliance with regulations, and improving care coordination...Full time
- A healthcare association is seeking a Manager of Utilization Management to oversee both internal and external UM functions. The role involves developing... ...federal regulations. Candidates must hold an unrestricted RN license in California, have at least two years of supervisory...
- ...in Chicago is hiring a Clinical Care Manager to oversee high-quality, patient-centered care through Utilization Review. The role requires an active RN license in Illinois and significant experience... ...position offers the flexibility of remote work while supporting professional...Remote work
- ...Department: Managed Services This position will be hybrid in the Dallas, Texas... ...open positions for this role. The Utilization Management (UM) RN performs utilization review activities... ...manner. This position is hybrid with remote and in-office assignment. SPECIFIC...Remote workWork at officeRelocation package
- ...A leading healthcare organization is seeking a Care Manager RN for a remote role primarily serving the state of Washington. This per diem position involves crucial utilization management activities, ensuring compliance with payer requirements and regulations. Candidates...Remote workHourly payDaily paidDay shift
$50 per hour
...Drips.com is looking for an Appeals RN (Temporary) to handle grievances and appeals effectively. This role requires... ...communication skills and a strong background in utilization management. The position is remote and offers a salary of $50/hr. In this position, you will...Remote workTemporary work$77.91k - $116.86k
...E2E Alignment Healthcare USA, LLC is seeking a remote Utilization Management Nurse to review prior authorization requests for medical necessity. The role requires a valid LVN or RN license in California, along with experience in nursing and utilization management. Successful...Remote work- ...MVP Health Care is seeking a Sub-Acute RN UM Reviewer-Medicare to join our Utilization Management team. In this remote role, you will conduct clinical reviews to ensure compliance with Medicare guidelines and support high-quality patient outcomes. The ideal candidate...Remote work
$45 - $45.5 per hour
...Overview Job Title: Nurse Case Management Senior Analyst Location: REMOTE Duration: 5-6 Months (Contract possibly... ...with the physician treatment plan. Utilizes clinical skills to assess, plan, implement... ...from more junior team members. RN and current unrestricted nursing...Remote workContract workImmediate startMonday to FridayAfternoon shift$35 - $58.63 per hour
...Dignity Health is seeking a Virtually Integrated Care RN to provide comprehensive remote support and collaborate in care coordination. This role involves developing personalized care plans and monitoring patient progress using telehealth technologies. Applicants must...Remote work- ...conduct physician-to-physician reviews. The candidate will support utilization review and ensure adherence to medical necessity criteria.... .... Strong communication skills and proficiency in utilization management are essential. This role offers a unique opportunity to...Remote job
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