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- ...Responsible for providing telephonic and e-referral case review and authorization of services utilizing established mental health and substance abuse medical... ...duties as required. This position is full-time, fully remote (work from home) and requires some weekend, evening,...Remote workFull timeWork from homeShift workWeekend workAfternoon shift
MRINetwork
United States1 day ago - Enlyte is seeking a qualified Utilization Reviewer who can work remotely from home. The ideal candidate performs utilization review on workers’ compensation related prospective, concurrent, and retrospective treatment referrals. The role requires clinical judgment to ensure...Remote workWork from home
Genex Services, LLC
New York, NY5 days ago - ...Coronis Health is seeking a remote Utilization Review Specialist to manage treatment authorization for behavioral health and substance abuse, interfacing with insurance and managed care entities. The role covers pre-certification, concurrent reviews, and appeals with a...Remote work
Santa Barbara Cottage Hospital
New York, NY1 day ago $55k - $70k
...support to behavioral health programs. We are looking for a Utilization Review (UR) Specialist in Boca Raton, FL Compensation: $55,000 -... ...position and must have prior UR & clinical experience. Remote hires and applicants without prior experience will not be considered...Remote workFull timeWork at officeQuadrant Health Group
Boca Raton, FL7 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, CA3 days 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, NY1 day ago- ...Utilization Review Specialist The Utilization Review Specialist plays a critical role in ensuring that healthcare services provided to patients are medically necessary, efficient, and compliant with regulatory standards. This position involves thorough evaluation of...Remote work
Bradford Health Services
United States1 day 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 States2 days ago - ...ABA Utilization Review Specialist Spectrum 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:...Remote workWork at officeFlexible hours
- ...Utilization Review Specialist | Remote | Full-Time Banyan Treatment Centers is seeking an experienced and detail-driven Utilization Review Specialist to join our corporate team. In this remote role, you'll manage a caseload of 5075 patients, conducting admission and...Remote workFull timeTemporary work
- ...Job Description Job Description 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 workWork at office
Oakland Community Health Network
Troy, MI19 days ago $63k - $65k
...Fortune Best Workplaces in Financial Services & Insurance RN Utilization Review As a nurse at Sedgwick, you can build a meaningful and rewarding... ...making an impact on the health and well-being of others in a remote work environment. Enjoy flexibility and autonomy in your...Remote workFull timeWork experience placementLocal areaFlexible hours- ...leading healthcare solutions company is seeking an experienced Utilization Review Nurse to improve patient care through home-based services.... ...accredited nursing degree and experience in utilization review. Competitive pay and remote flexibility offered. #J-18808-Ljbffr...Remote work
Medix
New York, NY1 day ago $41.6k - $47k
...Utilization Review Specialist At Umpqua Health, we're more than a healthcare organization we're a community-driven Coordinated Care Organization... ...with the ability to stay organized and productive in a remote, independent work environment Proactive communication with...Remote workWork at officeLocal areaImmediate startMonday to FridayFlexible hoursShift work- ...Technician to support retail pharmacy operations remotely. This role involves processing prescriptions, performing prior authorization reviews, and coordinating care for patients.... ...pharmacy, ideally with experience in utilization review. A strong knowledge of insurance processes...Remote work
The Judge Group, LLC
New York, NY4 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 workContract work
IntePros
Phoenix, AZ3 days ago - ...Partners is seeking a licensed Practical Nurse (LPN/LVN) experienced in managed care UM to perform pre-service and post-service utilization reviews and appeals for DMEPOS, working with our Medical Director in a NCQA-compliant UM program. You will review benefit and medical...Remote work
Santa Barbara Cottage Hospital
New York, NY1 day ago - ...Job Title Utilization Management Nurse Job Description The Corporate UM and Denials... ...team is responsible for: medical necessity reviews, admission status determinations,... ...Ambulatory/Admin - Office for 3 months, then remote/hybrid. Promotes and facilitates...Remote workWork at office
- ...Optum is seeking a Remote RN to perform clinical coverage review services and communicate benefit determinations. You will interpret mandates, work with... ...reliable internet. A Bachelor's Degree is preferred and experience with utilization review is a plus. #J-18808-Ljbffr...Remote workFlexible hours
Optum
El Segundo, CA1 day ago - ...Providence is seeking a Utilization Review RN for a remote, full-time role in the California region. The position involves performing prospective, retrospective, and concurrent utilization reviews, reviewing medical records daily during admission for all payers, and applying...Remote workFull time
Providence Service
Irvine, CA2 days ago - ...A healthcare services provider is seeking a Remote Utilization Review Nurse to coordinate clinical resources, ensuring compliance with healthcare standards. Responsibilities include processing authorizations, reviewing documentation, and collaborating with teams to meet...Remote workContract work
IntePros
New York, NY1 day ago $85.99k - $105.34k
...A community-focused healthcare organization in Oregon is seeking a Utilization Review Nurse for a full-time remote position. The role involves evaluating clinical service requests, conducting prior authorization reviews, and collaborating with interdisciplinary teams....Remote workFull timeUmpqua Health
Roseburg, OR3 days ago$30 - $38 per hour
...A healthcare organization is seeking a part-time Utilization Review Nurse RN to conduct assessments and reviews for medical necessity of treatment requests. This role involves working 28 hours per week with responsibilities such as providing reviews for pre-certification...Remote workHourly payPart timeSanta Barbara Cottage Hospital
New York, NY1 day ago- ...As a full-time Maryland Licensed Utilization Review Nurse working remotely, the candidate will monitor care appropriateness for plan members, evaluate benefits and medical criteria for service authorization, and communicate decisions regarding covered services. Key responsibilities...Remote workFull time
Virtual Vocations Inc
United States1 day ago - ...TurningPoint Healthcare Solutions is hiring a Utilization Review Nurse to work remotely. The ideal candidate must hold a valid LPN or RN license and possess strong critical thinking and clinical expertise. Responsibilities include performing initial clinical reviews, assisting...Remote work
TurningPoint Healthcare Solutions
Florida, NY5 days ago - ...Centene is seeking an Utilization Review Clinician - ABA to assess medical appropriateness of ABA services for members. The role emphasizes... ...credentials and 2–4 years of experience, including ABA exposure. Remote work with MO location, full-time day shift, and competitive...Remote workFull timeDay shift
IntelliResume
Kansas City, MO1 day ago - ...CVS Health is hiring a Utilization Management Nurse Consultant focused on Medical Review. This fully remote role supports timely, medically necessary care through expert clinical review and provider collaboration. The position requires an active RN license, 3+ years...Remote workFull time
Hispanic Alliance for Career Enhancement
Jefferson City, MO1 day ago $45 - $50 per hour
...Greenlife Healthcare Staffing is looking for a dedicated Registered Nurse Clinical Reviewer for a fully remote position in New York. This role involves conducting utilization and quality reviews and contributing to clinical studies. With a competitive pay of $45 - $50...Remote workHourly paykozmetickesluzby.vecnakraska.sk - Jobboard
New York, NY1 day ago- 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 jobContract workWork from home
- ...Performing medical record reviews for severity of illness and intensity of service, the part-time Registered Nurse Utilization Review will liaise with external review agencies to ensure... ...from established pathways in a remote setting. Key responsibilities: Collect...Remote workPart time
Virtual Vocations Inc
United States1 day ago
