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$39.32 - $48.06 per hour
...Ready to Help Us Transform Healthcare? Bring Your True Colors to Blue. The RN Utilization Management Reviewer is responsible for facilitating care for members who may have complex healthcare needs, authorizing medically necessary services at the right level of care...SuggestedHourly payFull timeWork at officeRemote workFlexible hoursShift workBlue Cross Blue Shield of Massachusetts
United States1 day ago- ...Registered Nurse Utilization Management/Episodic Case Manager (UM/ECM - RN) Reviewer Responsible for the coordination and efficient utilization of health care resources for Cook Childrens Health Plan (CCHP) members. Works with the Department Manager and Team Lead to...Suggested
Cook Childrens
Fort Worth, TX1 day ago $115k
...Perinatal Reviewer Perinatal Reviewer can work anywhere in the United States. Perinatal Reviewer, with minimal immediate direction or... ...standards and functionality of care delivery systems. Perinatal RN Reviewer must have the credentials, presence and expertise to earn...SuggestedCurrently hiringImmediate startThe Joint Commission
Staten Island, NY2 days ago$45 - $50 per hour
...Position Summary: The Clinical Nurse Reviewer is focus on auditing the IP UM process and identifying process improvement measures to... ...position at commencement of employment is expected to be between RN's $45 - $50 per hour ; however, base pay offered may vary depending...SuggestedHourly payFull timeContract workWork experience placementCasual workRelocation packageFlexible hoursRegal Medical Group
Canoga Park, CA4 days ago- ...REGISTERED NURSE (RN) - OASIS AND ICD-10 REVIEWER / ESPISODE ASSESSMENT COORDINATOR - HOME HEALTH SERVICES Join the PruittHealth @Home family, where we deliver quality care where the patients choose to be! We know that home is where the heart is, and thanks to our...SuggestedFlexible hours
PruittHealth
Norcross, GA2 days ago $87.65k - $98.6k
...Join VillageCare as a Full Time UAS RN Reviewer and elevate your nursing career in an innovative, fully remote environment! This role offers the chance to apply your expertise in a customer-focused healthcare setting while being a crucial part of a dynamic, forward-thinking...SuggestedFull timeWork at officeRemote workMonday to FridayFlexible hoursVillageCare
New York, NY4 days ago- ...Join a dedicated healthcare team in the Midwest region as an Advanced Cardiac Cath Lab RN Reviewer focused on quality assurance. This role involves meticulous collection and submission of clinical data to national registries, ensuring accuracy and compliance in both inpatient...SuggestedWork at office
MLee Medical Employment
Koeltztown, MO3 days ago $60 - $85 per hour
...learning. About the role We're looking for an experienced registered nurse to join our content quality team as an Expert Question Reviewer for NCLEX-RN exam preparation materials. You'll review practice questions across all NCLEX-RN content areas — including Medical-Surgical,...SuggestedHourly payContract workRemote workFlexible hoursStudyfetch
Beverly Hills, CA16 hours ago$60 - $85 per hour
...A leading education technology firm is seeking an experienced registered nurse for a remote Expert Question Reviewer role in NCLEX-RN exam preparation. You will evaluate practice questions for clinical accuracy and alignment with NCSBN standards. The ideal candidate will...SuggestedHourly payContract workRemote workFlexible hoursStudyfetch
Beverly Hills, CA16 hours ago$36 - $38 per hour
...Lead RN Reviewer Cohere's Service Operations team is responsible for ensuring that our healthcare partners are supported throughout their lifecycle of using the platform. The Lead RN Reviewer in Service Operations position is a crucial role in our organization. In this...SuggestedHourly payRemote workFlexible hoursCohere Health
United States2 days ago- Industrial Asset Management Council, Inc is seeking a Surgical/Clinical Reviewer in Missouri. The ideal candidate will have a nursing background and will work on reviewing surgical data and charts. Responsibilities include data collection for the ACS NSQIP program and...Suggested
- A healthcare provider in Columbia, SC is seeking an experienced RN OASIS and ICD 10 Reviewer to join their Home Health Services team. The ideal candidate must have active RN licensure and ICD-10 certification, showcasing experience with OASIS documentation. This role involves...Suggested
- Cook Children's in Fort Worth, TX seeks an RN Reviewer for full-time position. The role involves coordination and efficient utilization of health care resources for Cook Children's Health Plan members, assessing clinical information and determining medical necessity for...SuggestedFull time
- Village Center for Care, Inc. is seeking a Full Time UAS RN Reviewer to enhance patient care in a remote environment. This role involves quality assurance checks on assessments, collaboration with Nurse Assessors, and ensuring state policy adherence. Candidates should possess...SuggestedRemote jobFull time
- Humana is offering a remote RN Internship designed for transitioning military service members and military spouses. Interns will perform clinical reviews, support healthcare providers, and engage with interdisciplinary teams. Must be an active RN in Kentucky or have an...SuggestedRemote jobInternship
- POSITION SUMMARY: The Prior Authorization RN is responsible for reviewing and processing medical prior authorization requests to ensure services are medically necessary, meet evidence-based guidelines, and align with the health plan’s policies. This RN plays a critical...
- ...company in Hingham, Massachusetts is seeking a Clinical Utilization Reviewer to facilitate appropriate care for members with complex... ...-5 years of relevant experience in clinical settings, an active RN license in Massachusetts, and strong analytical skills. This position...Remote job
- RN Quality Reviewer page is loaded## RN Quality Reviewerremote type: Not Remotelocations: Brooklyn, NYtime type: Full timeposted on: Posted Todayjob requisition id: R-100485**Job Description:**The Position: Quality Reviewer RNSchedule: Monday - Friday 8:30 AM - 5:00 PMThe...Work at officeLocal areaMonday to Friday
- A leading pediatric healthcare organization is seeking a Utilization RN II responsible for managing medical necessity for inpatient admissions. The role demands expertise in utilization management and collaboration with healthcare providers. Candidates should have at least...Remote job
- ...leading healthcare solutions provider is seeking a Clinical Care Reviewer to evaluate medical necessity for inpatient and outpatient... ...or BSN, a minimum of 3 years of clinical experience, and a valid RN license in the District of Columbia. The position offers a competitive...Remote job
- ...Brooklyn is looking for a Registered Nurse to join as a Quality Reviewer. This full-time position requires ensuring the accuracy of documentation... ...with CMS standards. Candidates should possess a New York State RN License and documentation skills. The role offers comprehensive...Full time
- Superior Dental Care, Inc. is seeking a remote Registered Nurse to manage health care resources effectively. The ideal candidate should have 3 years of relevant experience, especially in clinical and case management, and be a graduate of a registered nursing program. Responsibilities...Remote job
- A major health insurance provider seeks an RN Utilization Management Reviewer based in Hingham, MA. In this full-time role, you will facilitate care for members with complex health needs, conducting reviews to authorize necessary services using your clinical skills. The...Remote jobFull timeWork at office
$39.32 - $48.06 per hour
The Role The RN Utilization Management Reviewer is responsible for facilitating care for members who may have complex healthcare needs, authorizing medically necessary services at the right level of care to promote optimal health. This position is self‑directed, works...Hourly payFull timeWork at officeRemote workFlexible hours- ...school of nursing with licensure, or eligible for licensure as an RN in the Commonwealth of Pennsylvania. Qualifications At least 3... ...Responsibilities Access to Care Conducts inpatient pre‑admission and admission review for Medicare and Medicaid beneficiaries, as well as private...Full timeWork experience placementWork at officeLocal areaImmediate startNight shift
- A healthcare provider in Boise is seeking a Clinical Documentation Specialist - RN to enhance clinical documentation and coding processes. Responsibilities include reviewing clinical documentation, ensuring compliance with regulations, and collaborating with staff for accurate...
$93.4k - $116.8k
...collection instruments. Facilitates quality assurance and utilization review activities with interdisciplinary teams on ways to improve and... ...Quality Scorecard, IPRO Projects, and CMS Quality Projects. For RN Quality Reviewer only: Provides clinical support in the...Work experience placementFlexible hours$38.92 - $60.33 per hour
...& Work Arrangement Location: Milwaukee, Wisconsin (Froedtert Hospital). Remote work is possible for this position. Job Summary The RN Diagnosis-Related Group (DRG) Auditor conducts targeted and random audits of finalized inpatient medical records to assess the accuracy...Hourly payTemporary workRemote work$2,454 per week
Job Overview Travel nurse RN Clinical Document Improvement Specialist located in Tarzana, California. Specialty: Clinical Document... ...management and patient safety operations Perform medical record reviews, including mortality chart reviews Qualifications Position:...Shift work$29.29 - $50.38 per hour
...the Licensed Practitioner of the Healing Arts (LPHA) authorizing Integrated Assessment and Treatment Plans. Will complete thorough review of each document, provide clinical guidance to team members, and ensure compliance with IATP standards. LPHA reviewer provides behavioral...Local areaImmediate startRelocationRelocation packageShift work
