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- ...Case Manager - Utilization Review Specialist - Remote Full-Time Position You must reside in one of these states to be eligible for position: Arkansas California Kentucky Massachusetts Nevada New Mexico Oregon Utah Tennessee Texas Wyoming The Utilization...Remote workFull time
- ...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,...Remote workDaily paidFull time
The Florida House
New York, NY1 day ago - ...Athens Administrators has an immediate need for a full-time Utilization Review Specialist to support our Managed Care department and can be located remotely if technical requirements are met and the employee resides in a state Athens operates in. The schedule is Monday...Remote workFull timeImmediate startMonday to Friday
Athens Administrators, Inc.
California-37 - ...and next steps. Our partner is looking for a Case Manager – Utilization Review Specialist based in the United States. Join a healthcare team... ...compliance with clinical and payer requirements. In this remote role, you will oversee admission and concurrent utilization reviews...Remote workFull timeLive in
$90.9k - $129.9k
...patient interactions for this role, rather you will provide utilization review and quality assurance. Your role in our mission Review... ...What you should expect in this role ~100% Remote home office. ~ Full-time position. Applications will be...Remote workFull timeWork experience placementHome officeFlexible hours$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 jobHourly payContract work$63.1k - $83.65k
...about making a difference by helping others. We are seeking a Utilization Review Specialist to perform utilization review of intellectual and... ...requirements for this position. While the position is remote, the individual in this position will have occasional travel...Remote workFull timeTemporary workMonday to FridayKent County Cmh Authority
Grand Rapids, MI4 days ago- ...Remote DUR Pharmacist Safe & Cost-Effective Medication Use Work From Home Analyze medication use patterns, apply clinical guidelines... ...collaborate with providers all from home. This remote Drug Utilization Review Pharmacist role is ideal for pharmacists who enjoy clinical...Remote jobWork from home
$69.39k - $88.61k
Cincinnati Children’s is seeking an experienced Utilization Review professional for a remote role in the United States. The position supports case management, authorization, compliance, and education within the Utilization Review department. The role requires a Bachelor...Remote jobFull time- ...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, MA4 days ago $63.1k - $90k
Utilization Review Registered Nurse (RN) - Remote Salary: $63,100-$90,000 annually + Bonus + Shift Differentials Medix is partnering with a leading national healthcare organization to hire Registered Nurses for a fully remote Utilization Review team! We are seeking RNs...Remote workCasual workWork from homeMonday to Friday10 hours per weekShift workRotating shiftAfternoon shift- ...-Cal Organized Delivery System (DMC-ODS), including review of medical records to ensure proper utilization of treatment resources and quality of care for clients... ...life of the eligible list. The option for hybrid remote work may be available based on the type of work and...Remote workContract workLocal areaTrial periodFlexible hours
- ...Job Description: Ascension Texas Utilization Management Department (Fully Remote)Job Summary:• Provides health care services regarding admissions, case management, discharge planning and utilization review.Responsibilities:• Reviews admissions and service requests within...Remote work
First Connect Health
Austin, TX2 days ago $60k - $70k
...alternative application process. Full Time Office/Clerical Remote, Birmingham, AL, US Salary Range: $60,000.00 To $70,000.00 Annually... ...for every stage of the journey. We are seeking a Utilization Review Specialist to add to our dynamic team! The Utilization Review...Remote workFull timePart timeWork at office- ...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
New Jersey-37 - Centene seeks an Utilization Review Clinician - Behavioral Health for a fully remote role serving New York. You will perform clinical reviews, assess care levels, and authorize mental health/substance abuse services. Requires a clinical license (RN or LMSW/LCSW/LMHC/LPC...Remote workDay shift
Centene Corporation
New York, NY3 days ago $1,600 - $1,800 per week
...Now Hiring: Registered Nurse – Utilization ManagementLocation: Buckley AFB & Peterson AFB,... ...No weekends, no holidays, no telehealth/remote workMinimum QualificationsU.S. Citizenship... ...in Utilization Management, Utilization Review, or Case ManagementPreferred Certifications...Remote workContract workImmediate startMonday to FridayJ Edward Staffing LLC
Aurora, CO3 days ago- ...Integra Partners is seeking an experienced LPN/LVN to perform pre-service and post-service utilization reviews and appeals in a managed care UM program. You will collaborate with the Medical Director to review benefit language, medical necessity, and appeals within NCQA...Remote work
Integra Partners
Michigan-37 $55k - $70k
...Requisition ID: 9619 Salary Range: $55,000.00 To $70,000.00 Annually Location: Remote (Statewide - Missouri) KVC Missouri is seeking a dedicated and detail-oriented Utilization Review Manager (URM) to serve as a vital link between our treatment teams, funding sources...Remote workFull time- ...Utilization Review Nurse Rising Medical Solutions has an opening for a Utilization Review Nurse, and we want to hear from you! We're a bill review and cost containment company - so what does that mean? Basically we are trying to fix a very broken healthcare system...Remote workFull time
Rising Medical Solutions
United States3 days ago - ...Partners is looking for an LPN/LVN experienced in the managed care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. This role collaborates with our Medical Director to conduct benefit and medical necessity reviews within...Remote job
- ...managed care experience to perform pre-service and post-service utilization reviews and appeals for DMEPOS. You will collaborate with our... ...InterQual and CMS guidelines. The role supports a nationwide remote workforce with competitive compensation, benefits, and a bonus...Remote job
- Lynn Rodens is seeking an experienced RN for utilization review work. The role involves reviewing medical records, identifying quality and utilization... ...US citizenship and DoD clearance eligibility. Position is remote with AZ hours (typically first shift). #J-18808-Ljbffr Lynn...Remote jobDay shift
- The Utilization Review Case Manager gathers demographic and clinical information on prospective, concurrent and retrospective in-patient admissions... ...of the Case Management department and of CorVel. This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identifies...Remote workMinimum wageFull timeWork at officeLocal areaFlexible hours
- ExamWorks is seeking a Utilization Review Nurse Auditor to perform quality utilization reviews and authorize medically necessary care. The role is fully remote with standard EST hours, requiring an active nursing license and coding certification. You will work with providers...Remote job
$63.1k - $90k
Medix is partnering with a leading national healthcare organization to hire Registered Nurses for a fully remote Utilization Review team. The role offers a base salary of $63,100-$90,000 per year with a 5% target annual bonus and up to 20% combined differential. The RN...Remote jobShift work- Sedgwick is seeking a Telecommuter RN for Utilization Review in Michigan. This full-time role focuses on evidence-based review of treatment plans, analyzing medical records, and coordinating with providers and claims teams. The position emphasizes accuracy, adherence to...Remote jobFull time
- Description Join our team as a remote (Oklahoma City) full time days and every other weekend RN Case Manager -Utilization Review at INTEGRIS Health, Oklahoma City, OK. Get to Know Your Team: INTEGRIS Health, Oklahoma's largest not-for-profit health system, is seeking a...Remote workFull timeWork at officeWeekend work
- ...compassionate behavioral health services. As a Behavioral Health Utilization Management Reviewer, you'll play a vital role in ensuring our members are in... ...of training/onboarding – this position is fully remote. Candidate must hold professional license in MA in order...Remote workHourly pay
Baystate Health
New York, NY23 hours ago - A leading independent review organization is seeking a Utilization Management Physician Reviewer for a full-time remote role. Candidates must possess an active Nebraska medical license and have a minimum of 5 years clinical practice experience. Responsibilities include...Remote jobFull timeCasual workMonday to Friday
