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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, CA6 hours ago- A therapeutic care provider is seeking a full-time Utilization Review Specialist to manage medical necessity reviews and secure authorizations for behavioral health services. This remote position requires prior experience in utilization review and knowledge of behavioral...Remote jobFull time
- ...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
$22 - $29 per hour
...usual. Work environment This opportunity is open to a remote, hybrid, or in-office working arrangement, in Fargo, ND. We empower... ...offers above the posted maximum. A day in the life The Utilization Review Technician is responsible for providing support for care...Remote workHourly pay16 hoursContract workWork at officeLocal areaImmediate startFlexible hoursBlue Cross Blue Shield of North Dakota
Fargo, ND6 hours ago$29.62 - $45.31 per hour
Description Providence Health Plan is calling an Associate Utilization Review Specialist who will: Be responsible for all core functions in... ...best people, we must empower them. This position offers 100% remote work and is open to candidates residing in: Oregon Washington...Remote jobWork experience placementLocal area- ...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
- ...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, CA1 day ago - ...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 workFull timeReliefLocal areaWork from homeMonday to FridayFlexible hoursShift work
BJC HealthCare
Saint Louis, MO4 days ago - ...prominent health organization is seeking a Family Medicine physician for a daytime position in a non-clinical utilization review setting. The role may allow for partial remote work and offers a competitive salary and incentives starting at $250K, alongside comprehensive...Remote work
Council Of State and Territorial Epidemiologists
Los Angeles, CA1 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, CA6 hours 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 States3 days ago - ...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
- ...Job Title: Care Review Clinician I | Utilization Review Nurse Location: Fully Remote Duration: 03+ months (possible extension) Schedule: After 6 weeks of training/onboarding → Sunday–Thursday or Tuesday–Saturday, 8:00 AM – 5:00 PM PST Pay rate: $40- $41/hr. on W2 CANDIDATES...Remote workLive inWork at office
Careers Integrated Resources Inc
Atlanta, GA3 days 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 jobContract work
- 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
- A healthcare organization is seeking a Physician Clinical Reviewer specializing in Cardiology to join their remote utilization management team. The ideal candidate will review service requests, consult with healthcare providers on clinical determinations, and ensure compliance...Remote job
- ...organization is seeking a Physician Clinical Reviewer for Nephrology, requiring a medical degree (DO, MBBS, MD). This remote role involves reviewing clinical cases,... ...professionals, and ensuring compliance with utilization management guidelines. Ideal candidates should...Remote job
- A leading managed care organization is seeking a self-motivated RN for a fully remote Utilization Review Nurse position. Responsibilities include assessing member needs, ensuring medical necessity of services, and collaborating with healthcare professionals. Candidates...Remote job
- A leading healthcare company is looking for an experienced Utilization Review Nurse to perform medical necessity reviews. This role emphasizes critical thinking and collaboration, requiring a bachelor's degree, active nursing license, and clinical experience. The position...Remote job
- A regional healthcare provider seeks an experienced nurse for a remote Utilization Management role. Responsibilities include managing prior authorizations and conducting medical necessity reviews for inpatient and outpatient services. Candidates must have a High School...Remote job
- ...Physician Reviewer – Utilization Management (Remote)-Full Time Overview We are seeking a Board-Certified Physician to support utilization management activities by reviewing clinical documentation and determining the medical appropriateness of inpatient, outpatient, and...Remote workFull timeLocal areaWeekend work
Medix
New York, NY2 days ago - A healthcare services organization is seeking a Clinical Care Reviewer II to perform medical necessity reviews for post-acute services... ...should have strong communication skills and a background in utilization management. This full-time position offers a competitive salary...Remote jobFull time
$76k - $85k
A leading public sector solutions firm is seeking a Utilization Review Nurse to perform clinical reviews and manage healthcare-related inquiries. This fully remote role involves communication with healthcare providers, utilizing clinical documentation to assess healthcare...Remote job- A healthcare organization is seeking a Physician Clinical Reviewer for cardiology on a remote basis. The role involves key responsibilities in the utilization management team, performing medical reviews and interacting with physicians. Candidates must hold a DO, MBBS,...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- A healthcare solutions company is seeking a Clinical Reviewer - LPN/LVN or RN for a remote role in the U.S. Responsibilities include reviewing medical... ...an active license, with 2+ years of experience in Utilization Review. The role requires strong clinical assessment skills...Remote jobShift work
$40 per hour
...Clinical Support Manager (temporary) to oversee workflow and process improvements remotely. This role requires strong clinical knowledge in acute care settings and experience with utilization review. Candidates should possess excellent communication skills and the ability to...Remote jobHourly payTemporary work- A regional healthcare provider in Houston is seeking a Utilization Management Review Nurse. This role involves evaluating the appropriateness of medical services based on necessity and promoting quality care outcomes. The candidate must have a Bachelor's in Nursing and...Remote jobFlexible hours
- ...leading healthcare organization is seeking a Utilization Management Nurse, Consultant in Rancho... ...role involves conducting utilization reviews and ensuring compliance with medical guidelines... ...offers a hybrid work model, blending remote and on-site responsibilities. Strong...Remote work
$75 - $90 per hour
...Immediate need for a talented Registered Nurse 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 interested...Remote workContract workLocal areaImmediate startPyramid Consulting
United States3 days ago
