Remote Utilization Management RN — Audits & Care Optimization
Optum
- Remote job
UnitedHealth Group in Massachusetts seeks a registered nurse auditor to review MDS/MMQ coding for facility payments. This role involves 75% travel across the state with occasional remote work based on business needs. You will audit medical records, discuss care plans, present findings and ensure HIPAA compliance. The ideal candidate holds an undergraduate degree or 4+ years nursing experience, a MA RN license, MDS/MMQ certification, and long-term care/health insurance experience. #J-18808-Ljbffr Optum
- ...receive high-quality care while efficiently utilizing medical resources.... ...patient outcomes and optimizing resource allocation.... ...Registered Nurse (RN) licensure in the state... .... Meets quality audit metrics within 90 days... ...to the on-site care management teams when appropriate...Remote jobPart timeWork experience placement
- WPS Health Solutions in Georgia seeks a Utilization Management RN to evaluate medical necessity and authorize services... ..., 4+ years in nursing, 2+ years in managed care, and strong coordination with health care teams. Remote work options are available in several states,...Remote job
- ProMedica is seeking a Utilization Management RN for a remote, part-time role in Ohio with a 20-hour work week. You will review admissions... ...authorizations, and collaborate with clinicians to optimize resource use and care quality. Qualifications include a NLN-accredited nursing...Remote jobPart timeWork from home
- WPS Health Solutions seeks a Utilization Management RN to assess medical necessity and authorize services... ...Services and Medical Directors to optimize care. The role requires 4+ years of RN... ...analytical and communication skills. Remote work options available within approved...Remote job
- ...MDS certification to perform comprehensive chart audits and ensure accurate coding for MDS/MMQ in... ...collaboration with clinicians to discuss patient care and justify decisions. Qualifications include an unrestricted MA RN license, MDS certification or proof, and experience...Remote job
$39 - $40 per hour
...Recruiter at The Judge Group Utilization Management Registered Nurse (RN) Type: 6-Month Contract W2 Location: Remote - but MUST reside in one... ...services, coordinating care, and ensuring members receive... ...monitor care options for optimal outcomes Conduct utilization...Remote workDaily paidContract workMonday to FridayShift workWeekend work- ...Plan is seeking an Inpatient Utilization Management Clinician to evaluate... ...ensuring medical necessity and optimizing health outcomes. This fully remote role involves supporting care transitions and collaborating... ...Candidates must have an active RN license and at least 2 years...Remote job
$80k - $90k
...Appeals Auditor (RN) is responsible... ...medical review audit work completed... ...as assigned by management. Monitors,... ..., and optimized business results... ...Experience with utilization management systems... ...such as Millimen Care Guidelines (MCG... ...independently in remote setting with...Remote workFor contractorsImmediate startWork from homeHome officeFlexible hoursShift work$35 - $40 per hour
...members. The company optimizes the entire member/patient... ...for clinical, case management, member engagement, provider... .... Job title: RN Utilization Management Reviewer... ...to the primary care team, specialty providers... ...This is a fully remote work at home role. You...Remote workHourly payTemporary workCurrently hiringMonday to FridayFlexible hoursWeekend work- ...we support patient care, research,... ...Brigham will coordinate optimal care for traditional... ...post-acute care utilization and readmissions.The... ...multidisciplinary management of patients with... ...backgroundRegistered Nurse (RN) licensure in... ...needs will vary.Remote work requires...Remote workFull timeMonday to FridayFlexible hours3 days per week
- Overview Work remote and travel 75%. Optum is a global... ...that delivers care, aided by technology to... ...partnering with onsite audits and projects. We have collaborative... ...UHC, or UBH (e.g. Case Managers, Field Care Advocates)... ...Current unrestricted RN nurse license in...Remote workCasual workWork at office
$98.55k - $147.83k
...conventional health care, committed to... ...and experienced Manager of Care Management... ...professionals. In this fully remote leadership role,... ...compliance, and optimal resource utilization across the... ...for a proven RN leader who is passionate... ...Maintain audit readiness by coordinating...Remote jobWork at office$2,263 per week
...Registered Nurse (RN) | Telemetry Location... ...: Please carefully read the submittal... ...directly with the manager after arriving onsite... ...monitoring*, Telemetry - remote monitoring*, Use... .... The client audits compliance documents... ...Lease agreement Utility Bill: Electric, Gas...Remote workPermanent employmentFull timeContract workLocal areaShift workNight shift$71.1k - $97.8k
...solutions company is looking for a Utilization Management Registered Nurse to interpret and... ...coordinate medical services. This fully remote position requires a Compact RN license and over a year of... ...established criteria and collaborating with care providers. The position offers a...Remote work$35 - $62.5 per hour
...Clinical DRG RN Auditor $10,00... ...that delivers care, aided by technology... ...advance health optimization on a global... ...Guidelines in the auditing of inpatient... ...overpayments. Utilizing excellent communications... ...Maintain and manage daily case... ...independently in a remote environment and...Remote workHourly payDaily paidMinimum wageFull timeTemporary workPart timeWork experience placementWork at officeLocal areaRelocation package$59.5k - $116.6k
...UnitedHealth Group is seeking a Utilization Management Nurse RN to work remotely from anywhere in the U.S. This role involves ensuring efficient health services... ...requires an active RN license and 3+ years of Managed Care or Clinical experience. The successful candidate...Remote workWeekend work$71.1k - $97.8k
...healthcare organization is seeking a Utilization Management Registered Nurse to support the... ...documentation of medical services. This remote position requires a valid RN license and clinical experience.... ...and ensuring appropriate care delivery. The role offers a pay range...Remote work$71.1k - $97.8k
...the United States is seeking a Utilization Management Registered Nurse to utilize... ...services and ensure appropriate care levels for members. This role... ...should possess a Compact RN license and at least one year... ...experience. The position offers a remote work option and includes a...Remote work- ...recruitment firm is seeking a Lead Healthcare Recruiter (Utilization Management RN) for a remote 6-month contract. The ideal candidate will have an... ...include evaluating healthcare services and coordinating care for members. Join a dynamic team and make a meaningful impact...Remote workContract work
- A leading healthcare organization is seeking a Care Manager RN for a remote role primarily serving the state of Washington. This per diem position involves crucial utilization management activities, ensuring compliance with payer requirements and regulations. Candidates...Remote workHourly payDaily paidDay shift
- ...healthcare organization is looking for a Utilization Management Registered Nurse to work remotely in Cheyenne, Wyoming. You will utilize... ...services and ensure appropriate care levels. The ideal candidate will hold a Compact RN license and have over one year of clinical...Remote work
- ...California is seeking a Supervisor of Utilization Management to oversee operations of the Pre-Authorization... ...facilitate team meetings. A California RN license is required. This position... ...and focuses on improving patient care and operational efficiency. Join us in...Remote work
- ...provider in Chicago is hiring a Clinical Care Manager to oversee high-quality, patient-centered care through Utilization Review. The role requires an active RN license in Illinois and significant... ...position offers the flexibility of remote work while supporting professional...Remote work
- ...Centene Corp. is seeking a Supervisor, Utilization Management (RN) to lead and supervise our Clinical Review team. This role focuses on ensuring appropriate care for our members and promotes adherence to compliance standards through effective team management and continuous...Remote workFlexible hours
$75.3k - $135.4k
...Corporation is seeking a Clinical Supervisor to oversee the utilization management team ensuring appropriate care for members. The ideal candidate will supervise day-... ...experience in a related field, along with an active RN license in California. This position offers a salary...Remote work- ...review company in Washington is seeking a Utilization Management Nurse Reviewer. The role involves... ...with healthcare providers to optimize care. Candidates must have a valid nursing... ...position offers a competitive salary range, remote work options, and a comprehensive benefits...Remote work
- ...designated as a regional Coordinated Care Organization (CCO) for... ...Together. This is a remote position in which we are able... ...experience: ~ ~ Health plan utilization management ~ Medicare and Medicaid rules... ...Current unencumbered Oregon RN License required within 90 days...Remote work
- ...Utilization Management Registered Nurse (UM RN) We're seeking a dedicated and detail-oriented... ...transitions of care and ensuring patients receive... ...policies). This is a fully remote opportunity requiring discipline... ...initiatives and process optimization. ~ Competitive...Remote work
$92.3k - $120k
...prioritize preventive care while leveraging data... ...who need it most. The Utilization Management (UM) team plays a vital... ...a Registered Nurse (RN), Home Health Utilization... ...opportunities to optimize care plans while promoting... ...in a fast-paced remote environment. Participate...Remote workFull timeWork experience placementWork at officeLocal areaFlexible hours- ...high-quality patient care across skilled nursing... ...some flexibility for remote work based on business... ...You'll Do Review and audit complete medical records... ...Active, unrestricted RN license in the state... ...~ Experience in utilization management, medical record review...Remote workWeekend workWeekday work
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