Remote Utilization Management RN
Arkansas Blue Cross Blue Shield
Provo, UT
- Remote job
Arkansas Blue Cross and Blue Shield is seeking an experienced Utilization Management Nurse (RN) to perform clinical reviews of prior approvals, network exceptions, and benefit inquiries. The role focuses on medical necessity, evidence-based care, and cost containment with a remote work option across multiple states.The ideal candidate is an RN with 4+ years of clinical practice in medical-surgical, ICU, or critical care areas, licensed in the relevant jurisdiction, and with familiarity inJ-18808-Ljbffr Arkansas Blue Cross Blue Shield
Vacancy posted 2 days ago
Similar jobs that could be interesting for youBased on the Remote Utilization Management RN in Provo, UT vacancy
- ...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
- ...Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation and benefit determinations... ...work within the One Home/Home Solutions team. This remote role requires compact RN license in your state, hospital/SNF/Home Health RN...Remote workWork from home
- ...CVS Health is seeking a Medicare Precertification Utilization Management Nurse Consultant to support a 24/7 operation. The role requires RN licensure, 3+ years of RN experience, and 1+ year in Med/Surg, with utilization management responsibilities across clinical criteria...Remote workWork from homeFlexible hours
- ...Arkansas Blue Cross Blue Shield is seeking an experienced Utilization Management Nurse to perform clinical reviews for prior approvals, benefit inquiries, and inpatient/outpatient services. This role requires interpreting evidence-based criteria, guidelines, and policies...Remote workWork from home
- ...Arkansas Blue Cross and Blue Shield is seeking an RN Utilization Management Nurse to perform clinical reviews for medical necessity across various services. The role involves weekend coverage and work from home within Arkansas and several western states. The ideal candidate...Remote workWork from homeWeekend work
- ...Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of... ...receive appropriate care in the right setting. This remote role requires US RN licensure in the state of residence and at least one year...Remote workWork from home
- ...is seeking a Medicare Precertification Utilization Management Nurse Consultant. The role involves applying... ...appropriate health services. Required RN licensure in the resident state, ~3+... ...and MS Office skills are essential. Remote work from home with strict HIPAA guidelines...Remote workWork from home
- ...Utilization Management Nurse at Cambia Health Solutions, Inc. works from home across Oregon, Washington, Idaho or Utah, with preference for Idaho/ Utah residents. The role performs prospective, concurrent and retrospective reviews to ensure medical necessity and appropriate...Remote workWork from home
- ...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 workWork from homeWeekend workAfternoon shift
- ...Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical... ...providers and members to facilitate care. The role emphasizes remote work, prior utilization management experience, and a BSN or...Remote work
- ...Humana is seeking a remote Utilization Management Behavioral Health Professional 2 in Indiana. The role requires an active RN license in Indiana, an ASN (BSN preferred), and 1+ year of clinical and managed care experience. You will coordinate with providers and members...Remote work
- ...Working remotely on a full-time basis, the Connecticut Licensed Utilization Management RN will manage medical necessity reviews, authorization compliance, and reimbursement optimization while serving as a liaison between providers and payers. Key Responsibilities Review...Remote workFull time
- ...Logan Health is seeking a Utilization Management Specialist to join our team in a fully remote role focused on inpatient admissions reviews, physician documentation assessment, and authorizations across the Logan Health system. The position emphasizes collaboration with...Remote work
- ...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
- ...WPS, a health solutions company, seeks an Utilization Management RN to evaluate medical necessity and service appropriateness for our Health Plan... ...in Case Management with potential growth into CM roles. Remote work is available in Colorado and other states; the...Remote work
- ...CVS Health is seeking a Utilization Management Nurse Consultant (Remote) to support Florida Medicare home-care requests. You will review cases, determine coverage... ..., full-time setting. The position requires an active RN license, 2+ years of experience (including 1+ year in...Remote workFull time
$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 Registered Nurse to interpret and support coordination of medical services and benefit determinations. You will work with a team handling post-acute care services including SNF, home health, and DME, reporting to the Manager...Remote work
- ...Humana is seeking a Utilization Management Registered Nurse who uses clinical nursing skills to interpret and support coordination, documentation... ...of medical services and benefit determinations. This remote role focuses on post-acute care services including SNF, Home...Remote work
- ...Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation, and communication of medical services... ..., members, and teams to facilitate care.The role requires an RN license in the state of residence, 1+ year of clinical RN...Remote work
- ...Humana is seeking a dedicated Utilization Management Registered Nurse to interpret and support medical services, benefit determinations, and coordination for post-acute care services. You will report to the Manager of Utilization Management and contribute to the One Home...Remote work
- ...OptumCare is seeking an HCBS Utilization Management Nurse in the greater Washington, DC area. You will perform pre-service clinical coverage reviews... ...with internal partners and external HCBS providers. A DC RN license and 2+ years of utilization management experience are...Remote work
- ...Humana is seeking a Utilization Management Registered Nurse to interpret and coordinate medical services and benefit determinations for post-acute care (SNF, Home Health, DME). The role reports to the Manager of Utilization Management and is part of the One Home/Home...Remote work
- ...Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation, and communication of medical services and benefit determinations. You will work with physicians and care providers to make determinations using established...Remote 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 jobWork from home
- ...Logan Health is seeking a Utilization Management Specialist to join our dedicated team. You’ll review admissions across the Logan Health system... ...coordination. The position offers a four 10-hour shift schedule, remote work with Montana residency, and a competitive benefits...Remote workShift work
- ...CVS Health is hiring a Medicare Precertification Utilization Management Nurse Consultant. The role requires nursing expertise to assess and coordinate... ...providers to ensure appropriate care and benefits. A BSN is preferred and a valid RN license is required. #J-18808-LjbffrRemote work
- ...Humana is seeking a Utilization Management Registered Nurse to interpret and coordinate medical services and benefit determinations for post... ...acute care including SNF, Home Health, and DME. You will work remotely, applying Milliman Care Guidelines or InterQual criteria to...Remote work
- ...Humana is seeking a Utilization Management Registered Nurse to interpret and support coordination, documentation and communication of medical services and benefit determinations. The role reports to the Manager of Utilization Management and belongs to the One Home/Home...Remote work
- ...Sentara Health Plans is seeking an RN Clinician for a remote role focused on utilization management and claim review. The position requires an active RN license (VA or Compact) and a BSN, with at least 3 years of acute care experience, including utilization review or...Remote work
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Utilization Management RN. Be the first to apply!
Related searches




