Remote Utilization Review RN III — Shape Care Decisions
Medica
Minnetonka, MN
- Remote job
Medica, a nonprofit health plan serving multiple states, seeks an Utilization Review RN to review and document member case history and determine clinical benefits in line with policies. The role requires attention to detail and clinical judgment. Responsibilities include prior authorization review, trend analysis, and collaboration with members, providers, and internal teams. Requirements: RN license, Associate or Bachelor's degree, and 5+ years of experience; remote work within Medica states. #J-18808-Ljbffr Medica
Vacancy posted 2 days ago
Similar jobs that could be interesting for youBased on the Remote Utilization Review RN III — Shape Care Decisions in Minnetonka, MN vacancy
- UnitedHealth Group is seeking a Utilization Management Nurse to ensure efficient and effective... ...determine medical necessity of level of care, and guide care decisions in a remote setting. Baseline requirements include Compact RN license and 3+ years in managed care or clinical...Remote job
- ...monitoring the utilization of behavioral health... ...Director for review. Refer to and... ...and efficient care delivery processes... .... Level III (in Addition To... ...responsibility, additional decision making, and in... ...and active NYS RN license... ...opportunity for remote work within all...Remote workContract workWork at office
- ...Fully Remote Utilization Review Position Setting: Fully Remote – Utilization Review... ...Requirements: Active RN license with Multi-State/... ...clinical nursing experience (acute care/hospital preferred)... ...will put you in front of the decision makers. We will provide feedback...Remote workFull timeMonday to Friday
HealthPlus Staffing
United States3 days ago - ...Fully Remote Utilization Review Position Setting: Fully Remote – Utilization Review... ...Requirements: Active RN license with Multi-State/... ...Minimum 3 years of acute care/hospital RN experience Strong... ...Direct access to hiring decision-makers Timely feedback throughout...Remote workFull timeMonday to Friday
HealthPlus Staffing
United States1 day ago - ...Remote: Yes Area of Interest: Nursing... ...0.4 Department: Utilization Management Shift... ...We are seeking an RN Utilization Management... ...of health care resources, provision... ...utilization management reviews using established... ...and to facilitate decision making. Requests...Remote workDaily paidTemporary workShift workWeekend work
UnityPoint Health
West Des Moines, IA3 days ago - ...Utilization Review And Management (Um) Component Program The utilization... ...at the appropriate level of care, while supporting regulatory... ...assess data and make informed decisions regarding patient care and... ...This is an in-office, no remote work capability position...Remote workWork at office
$35 - $45 per hour
Position: RN / Utilization Review Nurse Location: Sacramento, CA (ON-SITE) Employment Type: Potential... ...timely, accurate, and compliant care decisions in accordance with established guidelines... ...working independently in a remote or office-based setting. Working Conditions...Remote workWeekly payContract workWork at officeMonday to Friday- ...Healthcare Resources seeks a Utilization Manager Registered Nurse (UMRN... ...from home in a fully remote role. The nurse will review cases, educate patients on appropriate care, and manage health care costs... ...hours per day, requiring an RN with a Bachelor's degree, state...Remote jobWork from homeMonday to Friday
- ...Registered Nurse (RN) for Critical Incident... ...Industry Health Care Job Description... ...be responsible for reviewing and evaluating... ...insights will help shape care decisions, improve service delivery... ...environment while utilizing technology to support remote and hybrid work...Remote workFull timeWork from home
The CKHobbie Group
Harrisburg, PA16 hours ago - ...Remote Drug Utilization Review Pharmacist Safe & Cost-Effective Medication Use Work from home analyze... ...U.S. pharmacist license, managed care, PBM, or health-plan preferred... ...communication. Why this role? You'll shape prescribing decisions that affect thousands of patients,...Remote jobWork from home
$78k - $88k
...Utilization Review Nurse- Remote It takes great medical minds to create powerful solutions... ...Use clinical criteria for decision-making, referring complex... ...guidelines. Maintain RN license and meet continuing... ...bring together people who care deeply about making healthcare...Remote workFull timeContract workWork at officeWork from homeFlexible hoursGainwell Technologies
United States3 days ago$1,949.74 per month
...Nurse Specialty Utilization Review Job ID 17979666... ...Title Utilization Review RN Weekly Pay $1949.7... ...Job Description Remote Utilization Review RN responsible... ...hospital guidelines in an acute care setting. Client Details...Remote workWeekly payShift workProvidence Health and Services
Eureka, CA16 hours ago- ...Remote Registered Nurse In this remote role, the RN will manage utilization reviews, ensuring patient care meets medical necessity standards. Responsibilities include assessing patient cases, collaborating with interdisciplinary teams, and utilizing Epic and InterQual...Remote workWeekly pay
Slate Healthcare
United States20 hours ago - ...Remote DUR Pharmacist Safe & Cost-Effective Medication Use... ...from home. This remote Drug Utilization Review Pharmacist role is ideal... ...license. Experience: Managed care, PBM, or health-plan... ...communication. Why This Role? Shape prescribing decisions that affect thousands of...Remote jobWork from home
- ...Hospital is seeking a nurse to join our Utilization Management team in a remote role. You will perform prospective, concurrent, and retrospective reviews to ensure medical necessity and... ...multidisciplinary team, coordinate with care teams, oversee CMS and payer regulations...Remote work
Ascension
Milton, FL3 days ago - ...RN Utilization Review Location: Torrance, CA Job Type: Travel Discipline: RN Specialty: Utilization Review Facility Setting: Short Term Acute Care (STAC) Accepting Locals per Radius Rule?: Yes Contract Length: 13 weeks Shifts: Days Shift Details...Remote workContract workTemporary workLocal areaShift work
Hired by Matrix
United States2 days ago - ...Utilization Management – Care Management Shift options: 8:00–16:30 PST or 9:00–17:30 PST. Every third... ...Assignment Details This is a 100% remote position. Requirements ~3 years... ...Perform utilization review and medical necessity determinations,...Remote workShift workWeekend work
Providence SoCal Shared Services Case Management
United States3 hours ago $70k - $75k
...Guidehealth leverages remotely-embedded... ...Description The Utilization Management Registered... ...performing utilization review activities in... ...services Quality of care concerns... ...improving inspires us to shape a better future... ...practices. Final base pay decisions are dependent upon...Remote workBi-weekly payFull timeTemporary workFor contractorsLocal areaWork from homeGuidehealth
Kenosha, WI16 hours ago- ...HealthHelp is seeking a remote Utilization Review clinician (RN/LPN/LVN) to support medical necessity determinations across client programs. You will... ...review cases, coordinate with providers, and ensure timely decisions in line with policy and regulatory requirements. Ideal...Remote workWork at office
HealthHelp
Houston, TX1 day ago - ...Job Description Job Description Utilization Review Specialist Job Description Unique opportunity... ...by our value of excellence in quality care for all and fostering a culture that... ...Records. Must have LPCC, LSW, LCDC III or RN. Utilization Review Specialist...
MARYHAVEN, INC.
Columbus, OH2 days ago - ** UTILIZATION REVIEW NURSE III - WASHINGTON STATE - PRE-SERVICE CLINICAL UR/UM ** **... ...REVIEW/UTILIZATION MANAGEMENT RN WORK EXPERIENCE HIGHLY... ...medical necessity, level of care, and duration of treatment required... ...Cross-Group Collaboration Decision Making Dependability...Temporary workWork experience placementLive inLocal area
- ...Utilization Management Registered Nurse Duration... ...utilization review and prior authorization... ...in managed care, utilization management... ...timely authorization decisions while maintaining... ...Registered Nurse (RN) license.... ...independently in a remote environment. Comfortable...Remote workContract work
US Tech Solutions
United States4 days ago - ...Job Details POSITION SUMMARY - RN Utilization Review POSITION DUTIES - Review... ...hospital-based) ~ Skilled experience with remote work LENGTH OF ASSIGNMENT - 1... ...organizations provide quality patient care that continually evolves to make...Remote workTemporary workShift workWeekend work
AMN Healthcare
Fort Myers, FL2 days ago - ...Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S., from clinics and hospitals to home-... ...community. Job Summary and Responsibilities As our Utilization Review RN, you will play a pivotal role in optimizing healthcare delivery...Remote work
CHI Health
United States1 day ago - University of Maryland Medical System seeks a Utilization Review Nurse for weekend shifts in Towson, MD. The role bridges care teams and insurers, ensuring medical... ...and nursing credentials. Training is partly remote with onsite start as needed. #J-18808-Ljbffr...Remote jobShift workWeekend work
- Sentara Health Plans is seeking an experienced Utilization Review Nurse (RN) for Imaging/Commercial with remote work eligibility. The role covers prior authorization... ...inpatient and concurrent review, and coordination of care across benefits and contracts. A Virginia-compact...Remote jobFlexible hoursWeekend work
- HonorHealth in Arizona seeks an Utilization Review RN Specialist to review and monitor utilization for cost-effective, high-quality care. This role ensures medical necessity across Medicare... ...with physicians and care teams. Remote work is available after training. #J-1...Remote job
$65k - $75k
Piper Companies is seeking a Remote Utilization Management/Review Nurse to evaluate member cases, ensuring medical necessity... ...with providers to make high-quality care decisions. The ideal candidate will hold an active RN license with relevant experience. The position...Remote job- ...Utilization Review Nurse We are seeking a detail-oriented and... ...-effective patient care. The ideal candidate is... ...licensed Registered Nurse (RN) with experience in... ...and authorization decisions. Monitor resource utilization... ...department. Remote, hybrid, or on-site opportunities...Remote workWork at office
Ova Technologies
Alpharetta, GA1 day ago - Ampcus Inc. is seeking a Utilization Management Specialist (Remote) to review medical necessity and authorization for clinical services. The role emphasizes clinical nursing expertise, care management experience, and adherence to guidelines and policies. The position requires...Remote job
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Utilization Review RN III — Shape Care Decisions. Be the first to apply!
Related searches
- optum rn Minnetonka, MN
- rn transport Minnetonka, MN
- icu rn Minnetonka, MN
- office rn Minnetonka, MN
- endoscopy rn Minnetonka, MN
- registered nurse Minnetonka, MN
- travel registered nurse rn Minnetonka, MN
- part time registered nurse Minnetonka, MN
- rn insurance assessment Minnetonka, MN
- care manager rn Minnetonka, MN