Remote Utilization Management RN
Cambia Health
Cambia seeks an Utilization Management Nurse to work remotely from OR, WA, ID or UT with preference to current employees and residents of Idaho and Utah. You will perform prospective/concurrent/retrospective reviews to promote quality and cost-effective care while ensuring proper payment for services.
The role requires nursing licensure, 3+ years in case or utilization management, and collaboration with interdisciplinary teams to support transitions of care and compliant documentation.
#J-18808-Ljbffr- ...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 workFull timeImmediate startShift work
- ...Arkansas Blue Cross Blue Shield is seeking an Utilization Management Nurse to perform clinical reviews of prior approvals, network exceptions, and... ...inpatient/outpatient procedures. The role requires an active RN license and a Bachelor's degree is preferred, with at least...Remote workWork from home
- ...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
- ...CVS Health is seeking an experienced Registered Nurse (RN) to join the Utilization Management team in a remote capacity. You will review clinical information to support coverage determinations and apply evidence-based criteria across the continuum of care. The role...Remote work
- ...Humana Inc. is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation and determinations for medical services and benefit administration.You will report to the Manager of Utilization Management and serve as a member of the...Remote work
- ...Cambia Health is seeking an Utilization Management Nurse who can conduct prospective, concurrent, and retrospective reviews to ensure medical necessity and proper care pathways. You will apply evidence-based criteria and consult with physicians as needed. In this role...Remote work
- 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
- ...Arkansas Blue Cross and Blue Shield is seeking an experienced Utilization Management Nurse (RN) to perform clinical reviews of prior approvals, network... ..., evidence-based care, and cost containment with a remote work option across multiple states. The ideal candidate...Remote work
- ...Humana is seeking a Utilization Management Nurse 2 to apply clinical nursing skills in coordinating and documenting medical services and benefit... ...candidate has an Associate Degree in nursing, an active compact RN license, and at least three years of geriatric care...Remote work
- ...Humana is seeking a Utilization Management Nurse 2 to apply clinical nursing skills to coordinate, document and communicate... ...–5:00pm EST schedule. The position supports remote work with occasional travel, and requires an RN with a compact license and 3+ years of geriatric...Remote workMonday to Friday
- ...Humana is seeking a Utilization Management Nurse 2 to support coordination, documentation, and communication... ...stakeholders. The position is remote with occasional travel to Humana offices for training or meetings. A compact RN license is required, along with at least...Remote work
- Cambia Health is seeking an Utilization Management Nurse to support care decisions from a home-based setup across several states, including Washington, Oregon, Idaho and Utah. The role emphasizes clinical judgment, cost-effective care, and policy-based reviews. The nurse...Remote jobWork from home
$26.01 - $68.55 per hour
CVS Health is seeking a Registered Nurse (RN) for Utilization Management. You will review clinical information to support coverage determinations,... ...providers to ensure appropriate care. This full-time role offers remote work from home in the United States, with a 40-hour...Remote jobHourly payFull timeWork from home$101.72k - $198.36k
...Location: California - Ability to work remote, but selected candidate must reside in... .... This position requires California RN Licensure. Candidates must have significant... ...or all of the following functions: utilization management, care management, behavioral health and...Remote workContract workWork experience placementWork at officeLocal area- Humana is seeking a Utilization Management Nurse 2 to support coordination, documentation, and communication of medical services and benefit determinations... ...The position operates Monday-Friday, 8:00am-5:00pm ET, with remote/work-from-home options and occasional travel to Humana...Remote jobWork from homeMonday to Friday
$70k - $75k
Utilization Management Registered Nurse (RN) - Remote Full-time WHO IS GUIDEHEALTH? Guidehealthis a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients...Remote workBi-weekly payFull timeTemporary workFor contractorsLocal areaWork from home- ...Ascension is seeking a Registered Nurse for Utilization Management in a remote-capable role. This position focuses on reviewing admissions and service... ...planning across the organization. The role requires Texas RN licensure and a nursing diploma, with benefits including comprehensive...Remote work
- CVS Health is hiring an experienced Registered Nurse (RN) for Utilization Management to ensure appropriate care at the right time through evidence-based review and coordination. This role supports 24/7 operations and may require evenings, weekends, and holidays from a...Remote jobWork from homeWeekend workAfternoon shift
$72.8k - $130k
...scheduling and there is an occasional opportunity for remote work based on business needs. As a Sr Utilization Management Nurse in the Springfield MA Regional Area, the... ...Qualifications: ~ Must be a Registered Nurse (RN) with a current, active, unrestricted RN License...Remote workMinimum wageFull timeWork experience placementCasual workLive inWork at officeLocal area- ...Job Title: Utilization Management Registered Nurse (UM RN) – SNF / MLTC Location: Remote (Must reside in NY, NJ, or CT) Schedule: Monday – Friday, 9:00 AM – 5:00 PM Position Type: Full-Time Position Overview We are seeking an experienced Utilization...Remote workFull timeMonday to Friday
$70.2k - $120.4k
...norm and every member feels valued.The Utilization Review RN will review and document member case... ...revision of medical policies and utilization management and/or clinical appeals policies.... ...RN license requiredThis position is a Remote role. To be eligible for consideration...Remote workWork experience placement$68.81k - $120.72k
...guidelines and regulatory requirements and manages concurrent and pre-bill denials to... ...concurrent authorizations for in-house patients, utilizing daily commercial authorization reports.... ...and CertificationsRegistered Nurse (RN) [Required]Accredited Case Manager (ACM)...Remote workLocal areaShift workWeekend work$39 - $40 per hour
...the job poster from The Judge Group Lead Healthcare Recruiter at The Judge Group Utilization Management Registered Nurse (RN) Type: 6-Month Contract W2 Location: Remote - but MUST reside in one of the following states: IL, TX, NM, OK, MT, TN Schedule:...Remote workDaily paidContract workMonday to FridayShift workWeekend work- ...timely discharges, and to refer members to other plan resources to meet their care conditions. Reports to the Health Plan Manager of Utilization Management. This position will be an integral member of the health plan’s medical management team. This position is a collaborative...Remote workCasual workWork at officeShift work
- ...Behavioral Health Utilization ManagerBehavioral Health Utilization Manager will perform concurrent and discharge reviews on assigned patients. Applies approved... ...Excel, Outlook, and telephone systems Work Schedule: Remote Other Requirements: Able to work independently...Remote workContract workWork experience placement
$65k - $68k
...Utilization Management RN (M-F FROM YOUR HOME OFFICE) HealthCare Strategies Description Do you want to work from the comfort of your own HOME? Do you want to work for a progressive company that is a leader in their industry? F/T 40-hour/week Position Monday...Remote workFull timeWork at officeHome officeMonday to Friday$75k - $100k
...Utilization Management RN (Registered Nurse) evaluates efficiency, appropriateness, and medical necessity for medical services, and procedures... ...skills, and experience. Work Location We are open to remote work in the following approved states: Colorado, Florida, Georgia...Remote workFor contractorsWork at officeLocal areaImmediate start- A healthcare management organization is seeking a Utilization Management Nurse to oversee health service utilization while... .... This role requires an active LPN/RN license, and candidates should have... ...benefits package including remote work options. #J-18808-Ljbffr Healthcare...Remote job
$38.91 - $60.31 per hour
...Reside In Colorado For This Fully Remote Position Location:... ...policy criteria. Provides case management and/or consultation for complex... ...as a Registered Nurse (RN). Minimum Experience: 3 years... ...experience. Preferred: 3 years of utilization or case management experience...Remote workFull timeTemporary workLocal areaFlexible hoursShift work- Humana is seeking a nurse to support utilization management. The Utilization Management Nurse 2 coordinates, documents and communicates medical determinations... ...will have an Associate Degree in Nursing, an active RN license in a compact state, and 3+ years of clinical...Remote job
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