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$275k - $300k
...Remote or hybrid Medical Director for MediCare service line 100% administrative, non-clinical role Work from home, but candidate... ...CME, PTO Requires 5+ years experience in Medicare Advantage Utilization Review/Utilization Management and an active unrestricted CA license...Remote workPermanent employmentFull timeWork from homeMonday to FridayIntegrity Healthcare
Sacramento, CA3 days ago- A leading healthcare services provider is seeking a Utilization Review & Quality Assurance Specialist to work from home. The role involves evaluating clinical documentation, ensuring compliance with client standards, and conducting peer review processes. Candidates must...Remote jobWork from home
- 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
- ...agency in Arizona seeks a Behavioral Health Prior Authorization Utilization Review Consultant. The role involves monitoring and evaluating... ...three years of healthcare experience. The position may offer remote work flexibility within Arizona, contributing to a supportive...Remote job
- A leading health organization is seeking an Associate Utilization Review Specialist to coordinate prior authorization reviews in a remote setting. The role demands a Bachelor's degree in a health-related field or equivalent experience in healthcare. Responsibilities include...Remote job
$33 - $38 per hour
...leading staffing and consulting firm is urgently hiring a Remote Clinical Review Nurse to review medical necessity cases and advocate for patients... .... This remote contract position requires 3+ years in utilization management and an active RN Compact License. The pay range...Remote jobHourly payContract workImmediate startWork from home- ...insurance firm in Warwick seeks a UM Specialist to handle medical review decisions, balancing clinical standards with excellent... ...Responsibilities include reviewing medical services and conducting utilization reviews. Ideal candidates have an Associate's degree and three...Remote jobFlexible hours
- 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
- ...Job Description JOB POSTING Spend only 1-2 hours a week and provide your expertise in Gastroenterology by conducting Utilization Reviews in the Utilization Management/Peer Review process. A current Indiana medical license is required (or current ‘Letter of Qualification...Remote jobFor contractorsVisa sponsorship
Medical Review Institute of America, LLC
West Valley, UT27 days ago - ...Job Description Medical Review Institute of America, (MRIoA), a national Independent Review Organization (IRO), specializes in... ...determine the appropriateness of treatments, known as Peer Review or Utilization Review. Key Benefits: Stay informed on the latest...Remote jobContract workFor contractorsVisa sponsorshipFlexible hours
Medical Review Institute of America, LLC
West Valley, UT27 days ago $18 - $20 per hour
...using evidence-based practices to help families heal. As our Utilization Review Specialist, you will be responsible for maintaining organizational... ...psychiatric and behavioral health services. This fully remote role requires strong clinical judgment, payor communication skills...Remote workFull timeHome office$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- ...Flexible Independent Contractor (1099) Remote Opportunity Oregon Medical License Required... ...MRIoA Founded in 1983, Medical Review Institute of America (MRIoA)is a nationally... ...(IRO) specializing in technology-driven utilization management and clinical medical review...Remote jobContract workFor contractorsFlexible hours
Medical Review Institute of America, LLC
West Valley, UT22 days ago $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- ...high-quality care through efficient medical resource utilization. Key responsibilities include reviewing medical records and collaborating with healthcare... ...areas and utilization review. The role supports both remote work and in-person collaboration, ensuring exceptional...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 job
- ...ensure high-quality, patient-centered care through effective utilization review. The candidate will be responsible for evaluating healthcare... ...’ experience in various healthcare settings. The position is remote and offers a competitive benefits package. #J-18808-Ljbffr GuidehealthRemote job
- ...emphasizes high-quality patient-centered care through detailed Utilization Review. Responsibilities include managing healthcare service... ...and over 5 years of relevant experience. The position is fully remote, offering competitive benefits including medical, dental, and...Remote job
- .... ABOUT MRIoA Founded in 1983, Medical Review Institute of America (MRIoA) is a nationally... ...(IRO) specializing in technology‑driven utilization management and clinical medical review... ...case requirements Additional Details Remote, work‑from‑home position—work anywhere...Remote workFor contractorsWork from homeFlexible hours
$28.41 - $43.47 per hour
...) Department Coordinate and execute the review and research functions required to support... ...Health Plan is calling an Associate Utilization Review Specialist who will: Be responsible... ..., etc.) This position offers 100% remote work for candidates residing in Portland...Remote jobMinimum wageFull timeWork experience placementShift work$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- ...Care Manager to advance patient-centered care through precise Utilization Review. This role demands clinical expertise to evaluate healthcare... ...years of experience in healthcare settings. The Company offers a remote work environment with various benefits, including healthcare...Remote job
- ...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, CA4 days ago - ...Manager to advance high-quality, patient-centered care through Utilization Review. The ideal candidate will have an active RN license in... ...healthcare services and coordinating care effectively. This fully remote position offers flexibility, competitive pay, and comprehensive...Remote job
$35 - $45.94 per hour
Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review team. Oscar is the first health insurance company built... ...the Supervisor, Utilization Review. Work Location: This is a remote position, open to candidates who reside in: Texas, Georgia,...Remote workHourly payFull timeWork from homeHome office- ...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 $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- ...for a role that allows you to make a meaningful impact while working from home? We're seeking a Utilization Review & Quality Assurance Specialist to join our fully remote team. This role offers a consistent 8:00am-4:30pm EST schedule , providing structure and work-life...Remote workWork at officeLocal areaWork from home
- ...benefit manager is seeking a qualified Physician Clinical Reviewer for nephrology to work remotely. This role involves reviewing clinical cases,... ...determinations with physicians, and ensuring compliance with utilization management guidelines. Ideal candidates will have a DO...Remote job
