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- Nationwide Children's Hospital is seeking a utilization review professional to evaluate behavioral health cases, ensuring medical necessity and... .... After a 90-day in-office training, the position offers remote work from home options. #J-18808-Ljbffr Nationwide-ChildrenRemote jobWork at officeWork from home
- ...Alliance Health is seeking a UM Clinical Specialist-LTSS for full-time remote work, NC-based. You will perform utilization reviews and authorizations for I/DD and TBI waivers, ensuring services meet clinical guidelines and are provided in the least restrictive setting....Remote workFull time
Alliance Health in
Morrisville, NC3 days ago - ...accredited college or university in Nursing, Social Work, Behavioral Health or related field required preferred.2-3 years of utilization review experience in behavioral health, addiction treatment, or managed care.Strong understanding of ASAM criteria, LOCUS, DSM-5, diagnostic...Remote workDaily paidFull time
The Florida House
Deerfield Beach, FL3 days ago - A leading medical review organization is seeking Board-Certified physicians in Gastroenterology for a flexible remote opportunity. This role requires conducting independent Utilization Reviews for just 1-2 hours per week, with no minimum commitment. Candidates must have...Remote workFlexible hours
Medical Review Institute
United States2 days ago - ...Philadelphia, PA, in recruiting an Emergency Medicine physician for a non-clinical utilization review role. The position offers a daytime schedule Monday through Friday with the potential for remote work part of the time. Salary with incentives starts at $250K+ and includes...Remote workPart timeMonday to Friday
Enterprise Medical Recruiting
Abington, PA4 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, CA4 days ago- ...ABA Utilization Review SpecialistSpectrum Billing Solutions offers industry-leading revenue cycle management services for healthcare providers... ...in a cohesive and rewarding environment. This is a fully remote or office/home hybrid position.Your Responsibilities:Review patient...Remote workWork at officeFlexible hours
Spectrum Billing Solutions
Skokie, IL1 day ago $50k
...the lives of patients and their families What to Expect (Job Responsibilities) Complete pre-authorizations, concurrent reviews, and internal utilization review assessments Consult with the multidisciplinary treatment team to gather necessary information for concurrent...Remote workAdvanced Recovery Systems LLC
New York, NY11 hours ago- Spectrum Billing Solutions is seeking an ABA Utilization Review (UR) Specialist to join their team. This fully remote or hybrid position involves reviewing clinical information and obtaining authorizations for ABA services. Candidates should have 3-5 years of relevant...Remote job
- Spectrum Healthcare Resources seeks a Utilization Manager Registered Nurse (UMRN) to work entirely from home in a fully remote role. The nurse will review cases, educate patients on appropriate care, and manage health care costs for dependents of active duty and eligible...Remote jobWork from homeMonday to Friday
- FHE Health is seeking a Utilization Review Specialist to manage clinical authorization processes and coordinate with insurance payers for timely authorizations. The role supports access to treatment while ensuring documentation reflects medical necessity and compliance...Remote job
- ...Utilization Review Specialist Remote, United States About the Role The purpose of this position is to ensure that the utilization process is thorough, organized and streamlined to provide the best possible length of stays for our patients. Given the complex nature...Remote work
Charlie Health
United States2 days ago - ...week. At Bradford Health Services, we don't just invest in our patients-we invest in our people. About the Role: The Utilization Review Specialist plays a critical role in ensuring that healthcare services provided to patients are medically necessary, efficient...Remote workPart time
ADDICTION AND MENTAL
United States1 day ago $70k - $100k
...part of the Surgery Partners network, is seeking an experienced Utilization Review Specialist to join its team in Addison, Texas. This position... ...is a hybrid opportunity offering the flexibility of three remote workdays per week while maintaining an onsite presence two days...Remote workPermanent employment2 days per weekTEKsystems
Addison, TX11 hours ago- A peer review organization is seeking a full-time remote Utilization Management Physician Reviewer. Ideal candidates must hold an MD, DO, or DPM degree with active board certification and unrestricted medical license in relevant states. The role involves performing detailed...Remote jobFull timeWork from home
- ...R1 RCM is seeking an experienced Utilization Review Author (RN) for our Physician Advisory Team. The role involves first-level admission and continued stay reviews using InterQual/MCG criteria and requires hospital-based UR or Case Management experience. The position...Remote workFlexible hours
R1 RCM
Nashville, TN1 day ago - ...Ascension Sacred Heart Hospital is seeking a nurse to join our Utilization Management team in a remote role. You will perform prospective, concurrent, and retrospective reviews to ensure medical necessity and alignment with reimbursement policies. Join a multidisciplinary...Remote work
Ascension
Milton, FL1 day ago - ...HealthHelp is seeking a remote Utilization Review clinician (RN/LPN/LVN) to support medical necessity determinations across client programs. You will review cases, coordinate with providers, and ensure timely decisions in line with policy and regulatory requirements. Ideal...Remote workWork at office
HealthHelp
Houston, TX4 days ago $80 per hour
...healthcare professionals experienced in prior authorization, utilization management, clinical review, medical necessity criteria, payer authorization... ...healthcare operations.This role supports current and upcoming remote consulting opportunities focused on AI-assisted prior...Remote workHourly payPart timeFor contractorsWork at officeFlexible hours24-MAG LLC
New York, NY11 hours ago- ...hospitals to help improve the health of individuals and the quality of life in our community. New Horizons is seeking an Utilization Review Specialist , who will be responsible for following up on patient accounts when authorization for stay is required, initiate...Remote workLocal area
New Horizons
United States3 days ago $219k - $286.9k
Oscar Health is hiring a Physician Reviewer to join our Utilization Management team. You will determine the medical appropriateness of inpatient, outpatient... ...information and applying evidence-based guidelines. This remote role in the United States offers work from home with...Remote jobWork from home- ...Responsible completion of assigned tasks related to preadmission reviews, continued stay reviews, medical necessity requests, and chart... ...appropriate services, in the least restrictive environment, utilizing proven clinical interventions will lead to the provision of safe...Remote workWork at office
We Level Up NJ
United States4 days ago $32.65 - $43.9 per hour
..., including weekends as needed. We are seeking Virtual Utilization Review Specialists to join our team. Essential job function include... ...Knowledge, Skills, and Abilities Required: This is a remote role which requires access to high speed internet...Remote workTemporary workWork at officeLocal areaEnsemble Health Partners
United States18 hours ago- HonorHealth in Arizona seeks an Utilization Review RN Specialist to review and monitor utilization for cost-effective, high-quality care. This... ..., and a strong collaboration with physicians and care teams. Remote work is available after training. #J-18808-Ljbffr...Remote job
$78k - $88k
...Utilization Review Nurse- Remote It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career in a fast...Remote workFull timeContract workWork at officeWork from homeFlexible hoursGainwell Technologies
United States19 hours ago- Ampcus Inc. is seeking a Utilization Management Specialist (Remote) to review medical necessity and authorization for clinical services. The role emphasizes clinical nursing expertise, care management experience, and adherence to guidelines and policies. The position requires...Remote job
$56.17k - $70.21k
...Salary Range: $56,165.00 To $70,206.00 Annually Job Summary Utilization Review Analyst conducts prospective, concurrent, and retrospective reviews... ...may occur outside of standard office hours. Hybrid (onsite/remote) work schedule available. The ideal candidate must be able...Remote workFull timeWork at office- ...Mass Digital Health is seeking a Clinical Reviewer LPN for a work-from-home position. The role involves performing retrospective medical... ...in a relevant medical setting, and the ability to work in a remote environment. Comprehensive benefits are provided, including medical...Remote workContract workWork from home
Mass Digital Health
Quincy, MA2 days ago $35 - $45.94 per hour
...Utilization Review Nurse Remote Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as...Remote workHourly payFull timeWork from homeHome officeWeekend workOscar Health
United States4 days ago- ...leading healthcare solutions company is seeking an experienced Utilization Review Nurse to improve patient care through home-based services.... ...an accredited nursing degree and experience in utilization review. Competitive pay and remote flexibility offered. #J-18808-LjbffrRemote work
Medix
United States4 days ago
