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- ...is looking for an experienced Registered Nurse in Peoria, Illinois. The role focuses on utilization review, clinical consultation, and effective patient support within a fully remote setting. Candidates should have an active Illinois RN license and significant...Remote workWork from home
Guidehealth
Peoria, IL1 day ago - ...Paid Holidays ~ Work-life balance. ~ Remote/hybrid setting (once trained) ROLE DESCRIPTION: This individual will utilize clinical knowledge and communication skills... ...individual will defer decision to a second level reviewer. This individual interfaces with case...Remote workTemporary workWork at officeWork from homeMonday to FridayFlexible hours
Hines & Associates Inc
Rockford, IL11 days ago $30 - $45 per hour
...and Medi-Cal operations, along with experience in Epic EHR and Utilization Review. The selected candidate will perform chart reviews, ensure... ...accuracy, and support Medicaid program metrics. This position is remote and offers a pay range of $30-$45 per hour with various...Remote workHourly payContract workPyramid Consulting
Long Beach, CA1 day ago$275k - $300k
...~ Remote or hybrid Medical Director for MediCare service line ~100% administrative, non-clinical role ~ Work from home, but... ..., PTO ~ Requires 5+ years experience in Medicare Advantage Utilization Review/Utilization Management and an active unrestricted CA license...Remote workFull timeImmediate startWork from homeMonday to FridayInspire Healthcare
United States4 days ago$23.15 - $30.03 per hour
...members to join our corporate team! Responsibilities The Utilization review tech essentially works to coordinate the utilization review... ...will also function as an SME to support the UR tech team and remote counter parts with the specific processes as applicable. The...Remote workFull timeWork at officeLocal areaShift workPrime Healthcare
Ontario, CA4 days ago- A leading insurance provider in Omaha, Nebraska is seeking a full-time Utilization Review Nurse to ensure effective management of injured workers' treatments. This role does not require prior utilization review experience and is perfect for skilled nurses looking to transition...Remote jobFull timeWork at officeWork from home
- New-Freedom-Ops-LL in Phoenix, AZ is looking for a Utilization Review Specialist to oversee utilization review activities across behavioral health care. Responsibilities include conducting reviews, ensuring compliance with regulations, and liaising with clinical staff...Remote job
- ...Manager to oversee high-quality, patient-centered care through Utilization Review. The role requires an active RN license in Illinois and... ...collaborating with providers. This position offers the flexibility of remote work while supporting professional growth and a comprehensive...Remote work
Guidehealth
Chicago, IL1 day ago $75k
...for a Registered Nurse (RN) to perform concurrent inpatient utilization reviews. The role requires a BSN and current nursing license, with preference... ...with health, dental, and vision benefits. The position is remote with a standard Monday-Friday schedule and a supportive work...Remote jobMonday to Friday- ...A leading healthcare analytics firm is seeking a Registered Nurse for a remote role focused on utilization review and clinical determinations. The position requires strong communication skills, 5+ years of varied healthcare experience, and an active RN license in Illinois...Remote work
Guidehealth
Chicago, IL1 day ago - ...Apply Refer a Friend Back Remote Work from Home Share This Page Share on Facebook Share on... ...found in a community hospital. What you will do: The Utilization Review (UR) Nurse performs UR and Payor management activities, which...Remote workCasual workReliefLocal areaWork from homeDay shift
Johns Hopkins Medicine
Columbia, MD1 day ago $45 - $50 per hour
...Utilization Management Nurse – Medicare Remote | California RN Required | Must sit in CA We’re partnering with a mission‑driven healthcare organization... ..., concurrent, and retrospective utilization reviews for Medicare members Apply evidence‑based clinical...Remote workContract workTemporary workWork from homeActalent
Rancho Cordova, CA3 days ago- ...experienced Registered Nurse for a clinical role focusing on utilization review and care coordination. The ideal candidate will have 5+ years... ...processes, and be proficient in Microsoft 365. This role offers remote work and a comprehensive benefits package including medical,...Remote work
Guidehealth
Rockford, IL1 day ago - ...Part-Time | Remote (U.S. Based) Medical Review Institute of America (MRIoA) is a nationally recognized leader in utilization management and clinical review services, delivering evidence-based solutions for more than Physician Advisor (Utilization Review) Part-Time | Remote...Remote workPart timeWork at officeWork from home10 hours per weekFlexible hoursShift workWeekend work
Medical Review Institute
Salt Lake City, UT1 day ago - ...Registered Nurse Utilization Review (Remote) This is a fully remote Utilization Review RN role supporting multiple service lines and levels of care, including Inpatient, Extended Hospital Outpatient, and Observation (OBS). Position Overview: This is a fully remote...Remote work
3B Healthcare, Inc.
Torrance, CA5 days ago - ...A major healthcare organization is seeking a registered nurse for a remote position focused on utilization review. Candidates should have 2 years of experience in a hospital setting and expertise in evaluating medical necessity. Responsibilities include assessing care...Remote work
BJC HealthCare
Kansas City, MO2 days ago - ...A healthcare administration company seeks a Utilization Management Nurse to perform medical necessity reviews while working remotely. The ideal candidate will be an active Licensed Practical Nurse (LPN) with strong proficiency in the Utilization Review process. Responsibilities...Remote work
Brighton Health Plan Solutions
Chapel Hill, NC1 day ago - A healthcare provider is seeking a Utilization Review Nurse to coordinate resources and ensure efficient delivery of home health care. This role involves monitoring patient admissions and ongoing care while ensuring adherence to guidelines. The ideal candidate will have...Remote workContract work
IntePros
Phoenix, AZ1 day ago - ...NeuroPsychiatric Hospitals is seeking a Utilization Review Nurse (RN) to coordinate patient services and ensure effective utilization of resources. This remote position supports multiple hospitals, with a focus on utilizing clinical guidelines for optimal patient care....Remote work
NeuroPsychiatric Hospitals
Indiana, PA8 hours ago - ...The Council of State and Territorial Epidemiologists is seeking a Clinical Utilization Review Nurse (RN) for a remote position focused on assessing healthcare services for medical necessity. Candidates must hold an active RN license in Alabama and have at least 3 years...Remote work
Council Of State and Territorial Epidemiologists
Sacramento, CA4 days ago $62.4k
...Location Address: Remote Office Santa Fe, NM 87501 Compensation Pay Range: Minimum Offer $62,400.00 Maximum Offer $95,305.60 Now Hiring: LTC Utilization Management Reviewer Summary: Build your Career. Make a Difference. Presbyterian is hiring a skilled...Remote workFull timeTemporary workWork at officeLocal areaImmediate startWork from homeShift workPresbyterian Healthcare Services
Santa Fe, NM3 days ago- ...A healthcare organization is seeking a Physician Clinical Reviewer specializing in Dermatology to join their utilization management team. This remote role involves reviewing medical service requests, collaborating with healthcare professionals, and ensuring compliance...Remote work
Prime Therapeutics
Baton Rouge, LA1 day ago - ...A healthcare organization is seeking a Physician Clinical Reviewer for a remote opportunity. In this role, you will be a key member of the utilization management team, performing medical reviews of service requests and collaborating with physicians to ensure compliance...Remote work
Prime Therapeutics
Carson City, NV1 day ago - ...COMAGINE HEALTH is seeking Clinical Utilization Review Nurses (RN) for a full-time remote position focused on assessing the medical necessity of healthcare services in Alabama. Candidates must hold an active RN license and possess a BA/BS in nursing, alongside a minimum...Remote workFull time
COMAGINE HEALTH
Seattle, WA2 days ago - ...A national medical review organization is seeking Board-Certified physicians in Neurosurgery to conduct independent Utilization Reviews. This flexible, fully remote opportunity requires only 1–2 hours per week with no minimum commitment. Candidates must hold a current...Remote workFlexible hours
Medical Review Institute
Dallas, TX4 days ago $49.34 - $76.59 per hour
...A leading healthcare organization is seeking a Utilization Review RN for a fully remote role in Oregon. Candidates must hold an Oregon Registered Nurse License and have at least 5 years of clinical nursing experience, particularly in collaboration with physicians. This...Remote workProvidence Health & Service
Portland, OR1 day ago- ...Advanced Health Coordinated Care Organization is hiring a part-time remote Utilization Review Nurse. The ideal candidate will be a licensed RN with experience in acute care and utilization review. Responsibilities include reviewing prior authorizations, ensuring quality...Remote workPart time
Advanced Health Coordinated Care Organization
Oregon, WI2 days ago $174.07k - $374.92k
...Oak Street Health, part of CVS Health, is seeking a Full-Time Utilization Management Physician Reviewer to ensure accurate coverage determinations for inpatient and outpatient services. This role requires at least one year of Utilization Management experience in Medicare...Remote workFull timeOak Street Health, part of CVS Health
Chicago, IL2 days ago- ...pharmacy benefits manager is seeking a Physician Clinical Reviewer specialized in Dermatology for a remote role. This position involves reviewing clinical... .... This is an opportunity to contribute to effective utilization management processes while working within a...Remote work
Prime Therapeutics
Tallahassee, FL1 day ago $85.99k - $105.34k
...A community-focused healthcare organization in Oregon is seeking a Utilization Review Nurse for a full-time remote position. The role involves evaluating clinical service requests, conducting prior authorization reviews, and collaborating with interdisciplinary teams....Remote workFull timeUmpqua Health
Roseburg, OR1 day ago
