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- A leading healthcare provider is searching for a Medical Director to support the Medical Management staff with utilization reviews, appeals, and pharmacy oversight. This role requires an MD or DO with at least 3-5 years of clinical experience and a current medical license...Remote jobFull timeWork from home
- A leading medical management firm is seeking a full-time Utilization Review Specialist to ensure efficient processing of Utilization Management... ..., along with knowledge of HIPAA regulations. This is a fully remote position, requiring standard business hours and a dedicated...Remote jobFull time
- ...leading health organization is seeking a Utilization Management Nurse Consultant to ensure... ...care. The role involves evaluating medical review cases and collaborating with providers,... ...You will work independently in this fully remote position, making critical decisions that...Remote job
- A healthcare management company is seeking a full-time Utilization Review Specialist for a remote position. The role focuses on efficiently processing Utilization Management and Independent Review requests, reviewing case requests, maintaining compliance, and delivering...Remote jobFull timeWork at office
- A leading healthcare organization in California is seeking an RN Utilization Review professional for a full-time remote role. The position entails conducting utilization reviews and managing a varied workload in a fast-paced environment. Required qualifications include...Remote jobFull time
$18 - $22 per hour
Our Ethos Medical Management Team is seeking a full-time Utilization Review Specialist (REMOTE) to play a key role in ensuring the efficient, accurate, and timely processing of Utilization Management and Independent Review requests for our clients. This role involves reviewing...Remote workHourly payFull timeWork at office- Title - Clinical Review Nurse - Concurrent Review Duration - 6 months Location - Remote TX Responsibilities Job Profile Summary Responsibilities Performs concurrent... ...in health management systems according to utilization management policies and guidelines Works with...Remote workWork from home
- Overview Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No Remote About Exact Billing Solutions Exact Billing Solutions is a unique team of medical billing professionals specializing in the substance use disorder, mental...Remote workWork at officeFlexible hours
- A national risk management solutions provider seeks a remote Utilization Review Case Manager in California to assess patient admissions and treatment. Responsibilities include certifying medical necessity and collaborating with healthcare teams. Applicants should have nursing...Remote job
- ...leading academic healthcare system is seeking an RN Manager for the Rev Cycle Department. This hybrid position requires overseeing utilization review operations across multiple sites, ensuring compliance and effective communication. Responsibilities include developing...Remote job
$29.62 - $45.31 per hour
Description Associate Utilization Review Specialist - Remote Providence Health Plan is calling an Associate Utilization Review Specialist who will: Be responsible for all core functions in the Prior Authorization (PA) Department Coordinate and execute the review and...Remote jobMinimum wageFull timeWork experience placementLocal areaShift work- A leading educational institution in Miami is seeking a Case Manager RN for Utilization Review. The role involves conducting medical necessity chart reviews and coordinating with the healthcare team to ensure optimal patient outcomes. The ideal candidate will have a Bachelor...Remote jobFull time
$40 per hour
Clinical Support Manager (temporary) Utilization Review RN/LPN Job Category : Advisory Services Requisition Number : CONSU005289 Posted : November 25, 2025 Full-Time Remote Locations Showing 1 location Remote United States Description About Sound Physicians: Headquartered...Remote workHourly payFull timeTemporary workPart timeWork at officeLocal areaWork from homeShift workWeekend work- ...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 States4 days ago - ...Medicine physicians to support our clinical review services. In this role, you’ll evaluate... ...a leading provider of technology-driven utilization management and clinical review services.... ...your medical expertise while working remotely from home. Reduce or step away from hands...Remote workFor contractorsReliefWork at officeWork from homeFlexible hours2 days per week1 day per week
$76k - $85k
A public sector solutions firm is seeking a Utilization Review Nurse to manage prior authorizations and reviews concerning healthcare costs.... ...with effective communication and problem-solving skills. This remote position offers a compensation range of $76,000 - $85,000, with...Remote job$108k
Utilization Review Nurse page is loaded## Utilization Review Nurseremote type: Remote (100% telework)locations: Seattle, WAtime type: Part timeposted on: Posted Todayjob requisition id: REQ-0000126422**Job Description****UW Medical Center** has an outstanding opportunity...Remote workFull timeWork experience placementWork at officeWork from homeShift workDay shift1 day per week- ...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 workLocal areaWork from homeMonday to FridayFlexible hoursShift work
- ...behavioral health and substance abuse case management through utilization reviews and care coordination. While not a member facing role, you'... ...the right level of care at the right time. This is a fully remote position with a Monday-Friday schedule during standard business...Remote workMonday to Friday
Optum
Sedona, Yavapai County, AZ3 days ago $76k - $85k
A leading public sector solutions firm is seeking a Utilization Review Nurse responsible for authorizations and reviews of health care costs.... ...of clinical experience in a managed care setting. This is a remote role with a salary range between $76,000 and $85,000. Strong...Remote job- A public sector solutions firm is seeking a Utilization Review Nurse to perform prior authorization reviews and utilize a medical management... ...communication skills and the ability to work efficiently in a remote environment while adhering to protocols and standards. This position...Remote job
- 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 jobContract work
- ...augmentation firm is seeking an experienced Clinical Reviewer RN to manage a clinically complex inpatient caseload remotely. The ideal candidate will have a current,... ...RN license and a strong background in utilization management with at least 3 years of experience...Remote jobContract work
- ...provider in Somerville, MA is seeking a knowledgeable UMCM to utilize clinical expertise for reviewing and approving physician requests. The ideal candidate... ...to manage multiple tasks effectively. This is a remote position with occasional onsite meetings. #J-18808-Ljbffr...Remote job
$76k - $85k
A leading public sector solutions firm is seeking a Utilization Review Nurse to perform prior authorizations and reviews. Candidates must hold... ...skills, along with the ability to work efficiently in a remote environment. Compensation ranges from $76,000 to $85,000 with...Remote job$76k - $85k
A public sector solutions firm is seeking a Utilization Review Nurse to perform medical management and review tasks in a remote capacity. The ideal candidate will have at least 2 years of clinical nursing experience and must possess effective communication and organizational...Remote job- ...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 States5 days ago - ...insurance provider in South Carolina is seeking an experienced professional to perform medical and pharmacy reviews, focusing on utilization management within a remote setting. Key responsibilities include decision documentation, educating customers, and supporting...Remote jobWork at office
- 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 levels...Remote job
- ...organization is seeking a clinical professional to change the lives of its 28 million members. In this role, you will perform clinical reviews and assess mental health and substance abuse care, ensuring the appropriateness of services. Ideal candidates will have a nursing...Remote job
