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$55k - $70k
Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No Remote Salary: $55K - $70K Who We Are Exact Billing Solutions is a unique team of revenue cycle management professionals specializing in the substance use disorder, mental...Remote workWork at officeFlexible hours- ...Provides support for clinical member services review assessment processes. Responsible for... ...the Molina care model. • Adheres to utilization management (UM) policies and procedures.... ...SharePoint Fast learner Remote work experience Must obtain NV RN Licensure...Remote workWork experience placementWork at office
Molina Healthcare
United States16 hours agonew $29.95 - $44.77 per hour
A national risk management firm is seeking a Utilization Review Case Manager to analyze clinical information for patient admissions and treatment. This remote position requires strong CPT and ICD coding knowledge, along with effective organizational and communication skills...Remote jobHourly pay- ...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 job
$211.2k - $277.2k
...Hi, we're Oscar. We're hiring a Physician Reviewer to join our Utilization Management team. Oscar is the first health insurance company built around... ..., Utilization Management. Work Location: This is a remote position, open to candidates who reside in: Arizona;...Remote workFull timeLocal areaWork from homeHome officeWeekend workOscar Health
New York, NY3 days ago- ...Experience by Specialty Pediatrics* ICU MS Case Management/Utilization Review Pre-Cert Review* Prior Authorizations* Retrospective... ...Commission/ Core Measure/National Safety Goals Additional Skills remote UR work CA and Medi-Cal experience/knowledge*Remote work
B2B Staffing Services
Torrance, CA20 hours ago $75 - $90 per hour
...Immediate need for a talented RN Case Manager - Utilization Review - Onsite-Santa Clara, CA. This is a 03+ months contract opportunity with long-term potential and is located in U.S(Remote) . Please review the job description below and contact me ASAP if you are...Remote workContract workLocal areaImmediate startPyramid Consulting
United States20 hours ago- ***Hybrid/Remote*** Orientation Location: 8501 Wilshire Blvd, Beverly Hills, CA Required: * RN license in CA * 3 years of clinical experience in hospital or urgent care * Utilization review experience * Knowledge of ICD10, CPT, HCPC * Familiarity with HMO, PPO, POS Preferred...Remote workLocal areaWeekend work
Zenex Partners
Beverly Hills, CA3 days ago $54.86k - $71.25k
...Job Description Summary The Utilization Review Registered Nurse is responsible for reviewing medical services to ensure they meet evidence-based guidelines and member benefit plans. This includes precertification, concurrent review, and retrospective review. The...Remote workMinimum wageCurrently hiringLocal areaWork from homeFlexible hoursConduent
United States2 days ago- ...Workday to use the internal application process. To learn how to apply for a faculty or staff position, please review this tip sheet. The purpose of the Utilization Case Manager RN is to conduct initial chart reviews for medical necessity and identify the need for...Remote workFull timeTemporary workWork at officeWorldwide
The University of Miami
United States20 hours ago $1,600 - $1,800 per week
...NOW HIRING: Registered Nurse - Utilization Management Location: Buckley AFB & Peterson... ...No weekends, no holidays, no telehealth/remote work Minimum Qualifications ~... ...in Utilization Management, Utilization Review, or Case Management ~• Preferred Certifications...Remote workContract workImmediate startMonday to FridayVarite
Aurora, CO3 days ago$33.6 - $51.39 per hour
...work-from-home team! This is a great opportunity for a local remote position. There is no communication with patients. This position... ...performing care for hospitalized patients ~2 years of Utilization Review (UR) experience reviewing hospital admissions for medical necessity...Remote workHourly payFull timeWork experience placementReliefLocal areaWork from homeMonday to FridayFlexible hoursShift workBJC HealthCare
Saint Louis, MO2 days ago- ...Dane Street, a nationally recognized Independent Review Organization (IRO), is expanding its panel of Physician Reviewers... ...Workers’ Compensation Board Certification to conduct Utilization Reviews. This is a fully remote, non-clinical role offering supplemental income with...Remote workPrice workExtra incomeFor contractorsFlexible hours
Dane Street
United States1 day ago - ...elevate outcomes, and love your Mondays as the Nurse Director Utilization Review and Case Management at an award winning hospital in the Bay... ...imaging, AI-assisted decision support, virtual nursing, and remote monitoring; clear investment in clinician well-being through...Remote workWeekend work
Clinical Management Consultants
Berkeley, CA3 days ago $76k - $85k
A leading public sector solutions firm is seeking a Utilization Review Nurse to work remotely. This role involves conducting prior authorizations, performing reviews, and using medical management software. The ideal candidate will have a nursing degree, at least 2 years...Remote job- A health insurance company is seeking a Physician Reviewer to join their Utilization Management team. This remote role involves determining the medical appropriateness of services by reviewing clinical information and adhering to evidence-based guidelines. Candidates must...Remote job
- 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 job
- A healthcare organization is seeking Clinical Utilization Review Nurses (RN) for a remote position to assess healthcare services in line with Alabama Medicaid requirements. Candidates must possess a BA/BS in Nursing, an active RN license in Alabama, and at least 3 years...Remote job
$264k - $277k
A leading health insurance provider is seeking a fully remote Physician Reviewer to assess care requests for compliance with medical guidelines... ...board certification as an MD or DO, and 1+ years of utilization review experience. Candidates should have 5-6+ years of clinical...Remote jobFlexible hours- An established industry player is seeking Board-Certified Orthopedic Spine Surgeons for a fully remote, non-clinical role in Utilization Review. This opportunity offers flexibility and supplemental income, allowing physicians to provide evidence-based opinions on treatment...Remote jobExtra income
$1,844.5 per month
...Details Client Name REMOTE (BMCHP - Remote) Job Type Travel Offering Nursing Profession Registered Nurse Specialty Utilization Review Job ID 36555393 Job Title Registered Nurse - Utilization...Remote workWeekly payFlexible hoursShift workCape Fear Valley Health System
Charlestown, MA16 hours agonew- ...We are hiring a Clinical Review Nurse for a remote California-based opportunity focused on appeals, grievances, medical necessity review, and utilization management . This Clinical Review Nurse role is ideal for an RN with strong experience reviewing complex medical...Remote work
A-Line Staffing Solutions
Alameda, CA3 days ago - A healthcare organization is seeking Board-Certified physicians in Oncology for a flexible, remote utilization review role. This position requires a Medical Degree (MD or DO) with a current license in Florida, Minnesota, or Oregon, and an active Board Certification in Medical...Remote jobFlexible hours
- A leading healthcare company is looking for a Physician Clinical Reviewer - Dermatology for a remote position. The successful candidate will review medical cases, interact with physicians, and ensure compliance with clinical guidelines. An MD/DO/MBBS degree is required...Remote jobWork from home
$76k - $85k
A leading public sector solutions provider is seeking a Utilization Review Nurse based in Atlanta, GA. The role involves conducting healthcare... ...and experience in a managed care setting to qualify for this remote opportunity. Competitive compensation ranging from $76,000 to...Remote job$76k - $85k
A public sector solutions firm is seeking a Utilization Review Nurse to perform prior authorization and clinical reviews. Candidates should... ...effective communication, and attention to detail while working remotely. Compensation ranges from $76,000 to $85,000, with...Remote job$40 per hour
...months Must reside in TX Full time remote Candidates must be based in TX. RN... ...for performing initial, concurrent review activities; discharge care coordination... ...guidelines. Provides information regarding utilization management requirements and operational...Remote workFull timeContract workWork at officeHireOps Staffing LLC
United States20 hours ago- ...Management Senior Analyst Location: TN (Remote in TX, IL, NM, OK or TN) Contract duration... ...with the physician’s treatment plan. Utilizes strong clinical skills to assess, plan,... ...management program objectives are met by reviewing the effectiveness of alternative care services...Remote workContract workImmediate start
- A national nonprofit organization is seeking Clinical Utilization Review Nurses (RN) based in Alabama. This full-time, remote position focuses on assessing the medical necessity and quality of healthcare services. Candidates must have a BA/BS in Nursing, an active Alabama...Remote jobFull timeHome office
- A growing healthcare company is seeking an entry-level Utilization Review Nurse for a fully remote position. Responsibilities include performing clinical reviews, assisting in quality improvement projects, and interacting with healthcare providers. Candidates must have...Remote job
