Remote Utilization Management Nurse - Appeals & UM
ISHE
Brooklyn, NY
- Remote job
Optum is seeking an Utilization Management Nurse to review patient records and craft defensible appeal letters according to process instructions. You will extract pertinent details, reference clinical guidelines, and ensure compliance with HIPAA and policies. Position offers telecommuting from anywhere in the U.S. with a 40-hour week; requires an RN license, 3+ years bedside nursing in ED/telemetry/ICU/CCU, and strong MS Office skills plus 45 wpm typing. #J-18808-Ljbffr ISHE
Vacancy posted 3 days ago
Similar jobs that could be interesting for youBased on the Remote Utilization Management Nurse - Appeals & UM in Brooklyn, NY vacancy
- ...Integra Partners is seeking a licensed Practical Nurse (LPN/LVN) experienced in managed care UM to perform pre-service and post-service utilization reviews and appeals for DMEPOS, working with our Medical Director in a NCQA-compliant UM program. You will review benefit...Remote work
Santa Barbara Cottage Hospital
New York, NY3 days ago - UnitedHealth Group's Optum is seeking a Utilization Management Nurse to review patient records and craft defensible appeal letters in accordance with OPAS guidelines. This role supports 40 hours per week, Monday-Friday, with telecommuting flexibility across the U.S. and...Remote jobMonday to Friday
- Brigham and Women's Hospital in Boston is seeking a Staff Nurse - Per Diem Rotating Day in Utilization Management. The role reviews denials, appeals, and ensures appropriate care levels with care coordination and finance teams. A BSN is required with RN licensure in Massachusetts...Remote jobDaily paid
$60k
...LVN experienced in the managed care payor... ...service and post-service utilization reviews and appeals for DMEPOS. This individual... ...an NCQA-compliant UM program. Salary: $... .../ABILITIES The UM Nurse’s responsibilities include... ...opportunities Remote Opportunities We...Remote workTemporary workLocal areaIntegra Partners
Troy, MI5 days ago- ...Job Description The Utilization Review Case Manager is responsible for... ...cases as needed to the UM Medical Director, UM... ...clinical knowledge and nursing expertise to conduct... ...; assists with appeals preparation and facilitate... ...Angeles, CA, 90048, US (Remote) Overtime Status...Remote workShift workNight shift
- ...Spectrum Healthcare Resources is seeking a Utilization Manager Registered Nurse (UMRN) to work entirely remotely from home. The nurse will review cases, educate patients... ...(compact preferred), and at least 2 years of RN UM experience (remote/hybrid preferred). #J-18808-Ljbffr...Remote workWork from homeMonday to Friday
SHR (Spectrum Healthcare Resources)
Honolulu, HI2 days ago - ...Entity: Corporate Services Department: Corp Utilization Management Location: Bala Cynwyd, PA/ remote Summary The Utilization Review Nurse is responsible for conducting timely and... ...preferred. Previous Utilization Management, Appeals, or Denials Management experience is...Remote work
- ...JOB SUMMARY The Utilization Management (UM) Prior Authorization (PA) Nurse is a full-time role with NeueHealth, dedicated... ...including readability standards and appeal information. Documentation... ...responsibilities are performed working remotely, carrying out detailed work...Remote workFull timeContract workWork at office
NeueHealth
Remote1 day ago $72.8k - $130k
...Sr Utilization Management Nurse Optum is a global organization that delivers care... ...occasional opportunity for remote work based on business needs... ...knowledge of process flow of UM, including prior authorization... ..., and/or clinical appeal and guidance reviews ~ Must...Remote workMinimum wageFull timeWork experience placementCasual workLive inWork at officeLocal area- ...CVS Health is seeking a Utilization Management (UM) Nurse Consultant for a fully remote, full-time role open to CST zone candidates. You will coordinate, document, and communicate all aspects of utilization and benefit management, ensuring appropriate care levels within...Remote workFull time
4062 Aetna Resources, LLC
Topeka, KS4 days ago $71.1k - $97.8k
...live safely and independently in their communities? As a Utilization Management (UM) Nurse, you will play a vital role in improving the health and well... ...in Illinois, Wisconsin, or Indiana. Workstyle: This is a remote position supporting members and providers throughout...Remote workFull timeTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to FridayHumana
Brooklyn, NY2 days ago$70k - $75k
...Utilization Management Registered Nurse (RN) - Remote The Utilization Management Registered Nurse is responsible for performing utilization review activities... ...improvement initiatives. Assisting in the development of UM/PHM Committee materials and packets, including review...Remote workBi-weekly payFull timeTemporary workFor contractorsLocal areaWork from homeGuidehealth
United States2 days ago- ...CVS Health is seeking an experienced Utilization Management (UM) Nurse Consultant for a 100% remote, full‑time role serving candidates in the EST or CST zones. You will coordinate, document, and communicate utilization and benefit management activities to ensure appropriate...Remote workFull time
Santa Barbara Cottage Hospital
New York, NY4 days ago - ...Utilization Management Registered Nurse (UM RN) We're seeking a dedicated and detail-oriented Utilization Management Registered Nurse (UM RN) to join... ...Advantage regulations (LCD/NCD policies). This is a fully remote opportunity requiring discipline, accuracy, and...Remote work
Appworks
United States2 days ago $60.2k - $107.4k
...UnitedHealth Group is seeking a Registered Nurse with at least 3 years of bedside nursing experience to support appeals, data extraction, and HIPAA-compliant communications. This full-time position is remote within the United States and offers a pay range of $60,200 to...Remote workFull timeWork at officeIntelliResume
New York, NY8 hours ago$71.1k - $97.8k
...Become a part of our caring community The Utilization Management Nurse 2 utilizes clinical nursing skills to... ...courses of action. Reports to the UM Nurse, Manager The Utilization Management... ...information. Travel: While this is a remote position, occasional travel to Humana'...Remote workFull timeTemporary workApprenticeshipWork at officeLocal areaWork from homeHome officeMonday to FridayShift workHumana
Florida, NY3 days ago$100k
...Experience 1-3 years Salary $100,000 Remote Job Job Description This is a remote position. The Utilization Management (UM) Nurse is responsible for conducting clinical... ...desirable, along with previous involvement in appeals, grievances, concurrent review, or...Remote workContract workWork experience placementYour IT & Corporate Recruiter
United States2 days ago$26.01 - $68.55 per hour
...UM Nurse Consultant We're building a world of health around every individual — shaping a more connected, convenient and compassionate... ...one person, one family and one community at a time. Utilization Management is a 24/7 operation and work schedule may include weekends,...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeAfternoon shiftOak St. Health
United States1 day ago$80k - $95k
...adjustment, population health, and utilization management. IntusCare empowers teams to... ...The Utilization Management Nurse plays a critical role in... ...related interactions Appeal Management - In cases of... ...location: This is a fully remote role based in the United States...Remote workINTUS INC
United States1 day ago- Valenz Health is seeking a Utilization Management Nurse to oversee and manage the UM process, ensuring the delivery of high-quality, cost-effective care for plan... ...with CMS, URAC, and other regulators. This fully remote role requires a US-based location, strong nursing background...Remote job
$32.01 - $68.55 per hour
...UM Nurse Consultant We're building a world of health around every individual — shaping... ...and one community at a time. Utilization Management is a 24/7 operation and work schedule... ...holidays, and evening hours. Fully Remote- WFH Schedule - M-F 10:30A-7:30P...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeAfternoon shiftAvery Healthcare Group Ltd.
United States21 hours ago- UnitedHealth Group is seeking a qualified Utilization Management Nurse to review patient records and craft appeal letters, ensuring accuracy and compliance. You will support OPAS and enterprise goals while collaborating across teams to deliver high-quality reviews. Requirements...Remote jobWork at officeFlexible hours
- Brighton Health Plan Solutions seeks an experienced Utilization Management Nurse (LPN) to perform medical necessity and benefit reviews remotely. You will work within UM processes, coordinate with partners, and ensure timely, compliant documentation and communications with...Remote jobWork at office
- ...Overview Work remote and travel 75%. Optum is a global... ...support payment to the nursing facility Discuss... ...UHC, or UBH (e.g. Case Managers, Field Care Advocates)... ...knowledge of process flow of UM including prior authorization... ..., and/or clinical appeal and guidance reviews Proficient...Remote workCasual workWork at office
Optum
Kingston, MA3 days ago - ...– from care navigation and management to payment integrity, plan... ...About This Opportunity: As a Utilization Management Nurse, you’ll oversee and manage... ...participants. You will review UM activities, including... ...You’ll Work: This is a fully remote position, and we’ll provide...Remote workFull timeImmediate startMonday to FridayFlexible hours
Vālenz Health
Brooklyn, NY4 days ago $34 - $35 per hour
...Utilization Management - Clinical Nurse - Work from Home! Utilization Management - Clinical... ...and results-oriented UM Clinical Nurse to join our... ...conversations and communicating appeal processes Distributed... ...- Prior Authorization Remote Registered Nurse (Remote...Remote workFull timeWork at officeWork from homeNight shiftBroadpath Inc
United States3 days ago$26.35 - $39.53 per hour
...Utilization Management Nurse, LVN/LPN Remote Who We Are NeueHealth is a value-driven healthcare company grounded in the belief that all health consumers... ...for all. Scope Of Role The role of the UM Nurse is to promote quality, cost-effective outcomes for...Remote workHourly payWork at officeNeueHealth
United States3 days ago- CVS Health is seeking an experienced Utilization Management (UM) Nurse Consultant for a 100% remote, full-time role open to EST residents across the U.S. You will apply clinical expertise to ensure members receive safe, appropriate and cost-effective care. Schedule: Monday...Remote jobFull timeMonday to FridayWeekend work
- ...Behavioral Health Utilization ManagerBehavioral Health Utilization Manager will perform concurrent and... ..., adhering to BH UM and Appeals policies and procedures... ...Bachelor's degree in nursing. Current state Registered... ...systems Work Schedule: Remote Other Requirements: Able...Remote workContract workWork experience placement
Harris Health System
Houston, TX4 days ago - ...Role BHPS provides Utilization Management services to its clients... ...Management Nurse performs medical necessity... ...coverage while working remotely. Primary Responsibilities... ..., Disease Management, Appeals & Grievances, and... ...years’ experience in a UM team within managed care...Remote workFull timeContract workWork at office
Brighton Health Plan Solutions, LLC
Chapel Hill, NCa month ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Utilization Management Nurse - Appeals & UM. Be the first to apply!
Related searches
- software engineering manager remote Brooklyn, NY
- system engineer remote Brooklyn, NY
- remote technical project manager Brooklyn, NY
- remote recruitment consultant Brooklyn, NY
- remote property manager Brooklyn, NY
- remote reviewer Brooklyn, NY
- remote insurance agent Brooklyn, NY
- remote no experience Brooklyn, NY
- remote life underwriter Brooklyn, NY
- remote medical coding supervisor Brooklyn, NY