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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 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
- ...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
- ...Diversity, Equity, and Inclusion Plan. Medicaid Utilization Analyst 12 This position functions as a clinical review professional responsible as the senior analyst... ...operational needs and within established limits, remote work and alternate or hybrid work schedule requests...Remote workWork at 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- 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
$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 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
$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- ...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, 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 - A health organization in New Jersey is seeking a Full Time Utilization Review Physician. In this hybrid role, the physician will oversee compliance with healthcare regulations and ensure accurate patient status determinations. The ideal candidate brings strong clinical...Remote jobFull time
$90.87 - $154.33 per hour
...company in Michigan is seeking a Physician Clinical Reviewer - Cardiology to join their utilization management team. The role entails reviewing medical service... ...from $90.87 to $154.33 based on experience, and provides a remote work option. #J-18808-Ljbffr Prime TherapeuticsRemote job- ...healthcare organization is seeking a Physician Clinical Reviewer to join their remote team in Providence, Rhode Island. This role requires conducting... ...experience, and possess strong communication and utilization management skills. Join us in improving healthcare services...Remote job
$90.87 - $154.33 per hour
A healthcare company is seeking a Physician Clinical Reviewer - Dermatology to join their utilization management team. This remote position involves reviewing medical service requests, interacting with physicians, and providing clinical justifications for appeals. The ideal...Remote job- ...pharmacy benefits manager is seeking a Physician Clinical Reviewer specialized in Dermatology for a remote role. This position involves reviewing clinical... .... This is an opportunity to contribute to effective utilization management processes while working within a...Remote job
- A leading pharmacy benefit manager is seeking a Physician Clinical Reviewer - Nephrology to join their remote utilization management team. This role involves reviewing clinical cases for medical necessity, collaborating with healthcare professionals, and maintaining documentation...Remote job
$90.87 - $154.33 per hour
A healthcare organization is seeking a Physician Clinical Reviewer for their utilization management team. This remote position is focused on cardiology and involves reviewing clinical cases that need medical necessity evaluations. Candidates should hold a DO, MBBS, or MD...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 healthcare company is seeking a Physician Clinical Reviewer - Cardiology to join their utilization management team. This remote role involves medical reviews of service requests and interaction with various healthcare professionals. Candidates should have a DO...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
$90.87 - $154.33 per hour
...healthcare management company is hiring a Physician Clinical Reviewer specializing in Cardiology on a remote basis. The ideal candidate must hold an MD, DO, or... ...based on experience. This role is essential to the utilization management team, focusing on patient-centered care....Remote job- ...pharmacy benefit manager is seeking a Physician Clinical Reviewer - Nephrology for a remote position. The ideal candidate will have a medical... ...and over 5 years of clinical experience, focusing on the utilization management process. Responsibilities include conducting...Remote job
$90.87 - $154.33 per hour
A healthcare solutions provider is seeking a Physician Clinical Reviewer - Nephrology to join the utilization management team in a remote setting. This role involves reviewing medical requests, engaging with physicians, and ensuring compliance with guidelines. Candidates...Remote job$90.87 - $154.33 per hour
A healthcare company is seeking a Physician Clinical Reviewer specializing in Ophthalmology for a remote position. The candidate will play a crucial role in the utilization management team, providing timely medical review of service requests. The role requires a DO, MBBS...Remote job- 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
