Remote Utilization Review Nurse (CA) - Managed Care

Spectraforce

Remote job

Spectraforce is seeking an Utilization Review Registered Nurse (Post-service Medical Review 3) for remote work in California. The role focuses on retrospective utilization reviews, medical necessity assessments, and line-by-line audit of hospital bills to ensure contract compliance and proper billing practices. Strong RN credentials in California and CMS guideline proficiency are required. Ideal candidates will have 5+ years in managed care, experience with inpatient reviews, and solid EMR and #J-18808-Ljbffr Spectraforce

Apply

Vacancy posted 5 days ago

Similar jobs that could be interesting for youBased on the Remote Utilization Review Nurse (CA) - Managed Care in Sacramento, CA vacancy

Remote Inpatient Utilization Review Nurse
...Alignment Health is seeking an inpatient review nurse to join our remote utilization management team. The nurse will collaborate... ..., cost-effective levels of care while maintaining safety and quality. The role requires a CA LVN/RN license, 3+ years in case management...
Remote work
Alignment Healthcare
United States
2 days ago
Utilization Review Registered Nurse
...Description: Nurses - are you looking for a change... ...in personalized managed health care, focused on what's important... ...-life balance. * Remote setting ROLE... ...This individual will utilize clinical knowledge and... ...decision to a second level reviewer. This individual...
Remote work
Temporary work
Monday to Friday
Flexible hours
Hines and Associates
Monroe Center, IL
4 days ago
Utilization Review Nurse-Remote-Contract
$40 per hour
...Insurance Or Managed Care Industry Registered Nurse (RN) $40/hour - Contract for 6 months... ...in TX Full time remote Candidates must be based... ...performing initial, concurrent review activities; discharge... ...Provides information regarding utilization management requirements...
Remote work
Full time
Contract work
Work at office
HireOps Staffing LLC
United States
2 days ago
Remote Utilization Review Nurse - CA, 3.5‑Month Contract
Akkodis is seeking a Concurrent Review Nurse for a remote role based in California. This position involves... ...activities, ensuring compliance with care standards, and collaborating with... ...problem-solving skills, and the ability to manage multiple tasks efficiently. This is a...
Remote job
Contract work
Akkodis
Sacramento, CA
5 days ago
Utilization Review Nurse
$40 - $50 per hour
Utilization review Registered Nurse ( Post service Medical Review 3) Working... ...8:00 AM - 05:00 PM) Remote in California 6+ Months... ..... The Utilization Management Nurse, Senior will... ...appropriate level of care. Also, you will be... ...review experience, CA RN Licensure Preferred...
Remote work
Contract work
Work at office
Local area
Shift work
Spectraforce
Sacramento, CA
5 days ago
Licensed Mental Health Therapist (LMFT, LCSW, LPCC) - Hybrid | Carlsbad, CA
$60 - $65 per hour
...LCSW, LPCC) – Hybrid | Carlsbad, CA $60–$65 per clinical hour |... ...without having to market yourself, manage insurance credentialing, or... ...compassionate, evidence-based care and enjoys being part of a collaborative... ...about our practice. xhyhwjd Remote working/work at home options...
Remote work
Contract work
Part time
For contractors
Private practice
Work at office
Work from home
Monday to Friday
Flexible hours
Weekend work
Afternoon shift
Weekday work
Mood and Motion Therapy
Carlsbad, CA
16 days ago
Area Service Manager - Los Angeles, CA
$90k - $115k
Area Service Manager - Los Angeles & Rockies - Remote Los Angeles,CA AreaBring more to life.Are you ready to accelerate... ...that truly matter with people that care for each other, our customers,... ...service KPIs such as applied time, utilization, first-time fix, PM completion,...
Remote work
Full time
Contract work
Work from home
Flexible hours
Night shift
Danaher Corporation
Los Angeles, CA
4 days ago
Registered Nurse - Utilization Review (Nursing)
$1,600 - $1,800 per week
...Now Hiring: Registered Nurse – Utilization Management Location: Buckley AFB & Peterson... ...no holidays, no telehealth/remote work Minimum... ...experience in direct patient care • 12 consecutive months in... ...Utilization Management, Utilization Review, or Case Management...
Remote work
Contract work
Immediate start
Monday to Friday
J Edward Staffing LLC
Aurora, CO
2 days ago
Utilization Review Nurse
$95k - $107.5k
...Full-time Description Title: Nurse Reviewer, Utilization Management Job Type: Full-time Location:... ...week in Brighton, MA office; 1 day remote FLSA Status: Exempt About Us... ...members receive appropriate, high-quality care in the most suitable setting. Within...
Remote work
Full time
Local area
Brighton Marine Health Center
Brighton, MA
5 days ago
Utilization Review Nurse
$77.08k - $119.47k
...Department/Unit: Care Management/Social Work Work Shift... ...00 Responsible for Utilization Management, Quality... ...Characteristics 1. Registered nurse with a New York State... ...to utilization review process. 8.... ...cannot be done from a remote location. Other Requirements...
Remote work
Shift work
Albany Med
Albany, NY
1 day ago
Utilization Management Claims Review Nurse RN II
$88.85k
...Utilization Management Claims Review Nurse RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Salary Range: $88,854.00 (Min... ...Max.) Established in 1997, L.A. Care Health Plan is an independent...
Full time
LOS Angeles Care Health Plan
Los Angeles, CA
5 days ago
RN Case Manager Experienced (IKC-CA)
$41 - $55 per hour
...RN Case Manager - Position Highlights REMOTE CKD/ESKD Location: The teammate must be based... ...CKD patients throughout CA, OR, NV, and Washington as... ...facilitate quality, cost-effective care while minimizing... ...our DaVita IKC Registered Nurse are: A.D.N degree from...
Remote work
Hourly pay
Minimum wage
Full time
Home office
Monday to Friday
DaVita
United States
1 day ago
Remote Utilization Review Nurse — Acute Care Focus
...Technologies, Inc. is seeking a Registered Nurse with utilization management experience to review ED admissions and apply InterQual... ...have 3+ years in acute care nursing and 2+ years in utilization... ...in EMR and MS Office. Remote work arrangements are supported where...
Remote job
Netsmart Technologies, Inc.
New York, NY
4 days ago
RN Case Manager Experienced (IKC-CA)
$41 - $55 per hour
...States of America RN Case Manager - Position Highlights REMOTE CKD/ESKD Location:... ...CKD patients throughout CA, OR, NV and Washington as needed... ...quality, cost-effective care while minimizing fragmentation... ...more than 600 dedicated nurses, care coordinators, nurse practitioners...
Remote work
Hourly pay
Minimum wage
Full time
Home office
Monday to Friday
DAVITA MED-CENTER AT HOME
United States
5 days ago
Utilization Review Nurse
Currently seeking a Utilization Management RN . Please see details... ...qualifications below: Position is remote - candidate must... ...PA license or a Nurse Licensure Compact to include... ...medical record review to determine medical necessity... ...to ensure appropriate care settings. Report...
Remote work
Immediate start
Day shift
The Judge Group
New York, NY
4 days ago
Utilization Review Nurse
$55 per hour
...hiring a Concurrent Review Nurse to support our client... ...Healthcare space. Location: Remote (must be based in... ...ensuring that member care is provided at the... ...: Experience in case management, utilization management, or discharge... .../Case Manager CA REMOTE California, United...
Remote work
Full time
Contract work
Temporary work
Local area
Akkodis
Sacramento, CA
5 days ago
Utilization Review Nurse
# Utilization Review NurseFully Remote • Involuntary Remote - ALL STATES - Remote All States, CA 90802## OverviewSalary Range$82,000.... ...Utilization Review Nurse**Please make sure to... ...requested medical care using evidence-based... ...with ongoing case management needs and refer these...
Remote work
Long distance
TRISTAR Company
Sacramento, CA
1 day ago
RN Case Manager Experienced (IKC-CA)
$41 - $55 per hour
...States of America RN Case Manager - Position Highlights REMOTE CKD/ESKD Location:... ...and CKD patients throughout CA, OR, NV and Washington as needed... ...quality, cost-effective care while minimizing... ...Our more than 600 dedicated nurses, care coordinators, nurse practitioners...
Remote work
Minimum wage
Full time
Home office
Monday to Friday
DaVita
El Segundo, CA
1 day ago
Utilization Management Denial Review Nurse - LVN
$65.8k - $130.8k
...Job Title Work Location: Los Angeles, CA, USA Onsite or Remote Flexible Hybrid Work Schedule Monday - Friday, 8:00am - 5:00pm PST Salary Range: $65,800 - $130,800/Annually Employment Type 2 - Staff: Career Duration indefinite Primary Duties And Responsibilities...
Remote work
Monday to Friday
Flexible hours
UCLA Health
Los Angeles, CA
2 days ago
Utilization Management Review Nurse (Outpatient)
$80k - $90k
...Health, Inc., located in Orange, CA is a premier healthcare provider... ...focus on delivering comprehensive care tailored to the needs of our diverse... ...of our members. SUMMARY: The Utilization Management Pre-Service (Outpatient) Review Nurse is responsible for managing inpatient...
Full time
Astiva Health, Inc
Sacramento, CA
5 days ago
Virtual Primary Care Physician - NY, DC or CA Licensed
$262k - $278.5k
...Us One Medical is a primary care solution challenging the... ...preventive care, chronic care management, common illnesses and mental health... ...and weekends) ~ Location: Remote, must reside in the United States... ...state license in either CA, NY or DC ~ Minimum of 15...
Remote work
Full time
Temporary work
Work at office
Afternoon shift
One Medical
Phoenix, AZ
1 day ago
Travel Nurse RN - Case Manager - $3,138 per week in San Francisco, CA
$3,138 per week
...Registered Nurse (RN) | Case Manager Location: San Francisco, CA Agency: Cynet Health Pay: $3,138 per week... ...Two days on-site and three days remote each week. BLS and CA RN licenses... ...preferred. Skills required include care coordination, medical necessity evaluation...
Remote work
Full time
Contract work
Shift work
3 days per week
Cynet Health
San Francisco, CA
1 day ago
Travel Nurse RN - Case Manager - $2,822 per week in Oakland, CA
$2,822 per week
...Registered Nurse (RN) | Case Manager Location: Oakland, CA Agency: Atlas MedStaff Pay:... ...healthcare agency should care about you. Our team has... ...recognitions are fueled by real reviews by real travel nurses... ...team has been working remote since the pandemic), but...
Remote work
Hourly pay
Full time
Contract work
Work at office
Shift work
Weekend work
TravelNurseSource
Oakland, CA
1 day ago
RN Care Manager - CA Licensed
$113k - $120k
...Senior Health Care Nurse One Medical is looking for nurses with care management or population health backgrounds to join our Senior... ...visits (in-person, video, remote) with patients focusing on prevention... ...this role: ~ Licensed RN in CA required, willingness to obtain...
Remote work
Full time
Temporary work
Live in
Work at office
Monday to Friday
Flexible hours
One Medical
Mill Valley, CA
3 days ago
Remote CA Senior Program Director - Care Coordination
Acentra Health seeks a Senior Program Director to lead a new CA UIS Care Coordination Program across California. You will oversee program... ...to ensure timely, equitable, person-centered support, managing care coordination workflows and transitions of #J-18808-Ljbffr...
Remote job
Acentra Health
Los Angeles, CA
5 days ago
Utilization Review Nurse Auditor (33034)
Utilization Review Nurse Auditor (33034)# Utilization Review Nurse Auditor (33034)Fully Remote • Mount Laurel, NJ 08054## OverviewSalary Range$33.0... ...review services and approving care that is medically... ...insight and direction to management on any compliance concerns...
Remote work
Local area
Monday to Friday
Network Medical Review Co.
Mount Laurel, NJ
4 days ago
Utilization Review Nurse
...Remote role but will need to go to Newark, NJ to pick... ...1. Conducts on-site reviews at participating provider... ...improvement and health management. 4. Assists the Quality... ..., preferably health care industry. 2. Requires License Practical Nurse License or an active New...
Remote work
Winston Staffing
Newark, NJ
1 day ago
Nurse Care Coordinator (RN) - Remote, CA License, Bilingual - Spanish
$95k - $110k
...reimagining pediatric chronic care, starting with ADHD. After successfully... ...now on Obesity and Overweight management. Our clinical model is tech-... ...at IDEO. Position Summary The Nurse Care Coordinator (RN) is an... .... Note this is a fully remote position. Key Responsibilities...
Remote work
Full time
Clarity Pediatrics
Oregon State
1 day ago
Utilization Review Nurse / Managed Care Expert
$85 per hour
...Requirements Must be eligible to work in Remote Fluent proficiency in English (Written & Verbal) Reliable high... ...3 months ~80% Why this role At $85/hr, this Utilization Review Nurse / Managed Care Expert position compensates Healthcare expertise on its...
Remote work
Hourly pay
Contract work
Ethos
United Kingdom
14 days ago
Utilization Review Nurse- Remote
$65k - $78k
...Your Role In Our Mission Review admissions, procedures, services,... ...findings and rationale in medical management systems. Assist in training new nurses, provide feedback, and stay updated... ...when you bring together people who care deeply about making healthcare work...
Remote work
Full time
Work at office
Work from home
Flexible hours
Gainwell Technologies LLC
United States
5 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Remote Utilization Review Nurse (CA) - Managed Care. Be the first to apply!