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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 workFull timeWork from home
Hispanic Alliance for Career Enhancement
Chicago, IL4 days ago $35.62 - $52.99 per hour
A healthcare organization in Rancho Cordova seeks a Utilization Review LVN to provide high-quality, cost-effective care while monitoring managed care patients. Responsibilities include managing patient charts, ensuring compliance with eligibility and review processes,...Remote jobHourly payWork from home$35.62 - $52.99 per hour
A nonprofit health system is seeking a Utilization Review LVN to provide high-quality, cost-effective care for patients. This role requires 3 years of Utilization Management and 5 years of LVN experience, along with a clear CA LVN license. Responsibilities include managing...Remote jobHourly payWork from home$40 - $45 per hour
...seeking an ER/ICU RN in Austin, TX. This fully remote contract position requires 4+ years of RN experience in utilization management and a Compact RN license. Responsibilities include performing concurrent health reviews, evaluating care delivery for necessity, and assisting...Remote workContract workActalent
Austin, TX2 days ago- A healthcare organization is seeking a remote Utilization Management Nurse Consultant to manage medical review cases and ensure timely patient care. The role requires an active RN license and at least 3 years of clinical experience, with expertise in utilization review...Remote jobFull time
- A leading behavioral health network in Texas is seeking a full-time UR Coordinator to implement the utilization review process. Responsibilities include monitoring client documentation for compliance, gathering information for insurance, and conducting peer reviews. The...Remote jobFull time
- ...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 work
Guidehealth
Chicago, IL4 days ago - ...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...Remote work
Guidehealth
Saint Louis, MO4 days ago - ...A leading healthcare analytics firm is seeking a Registered Nurse for a remote role focused on utilization review and clinical determinations. The position requires strong communication skills, 5+ years of varied healthcare experience, and an active RN license in Illinois...Remote work
Guidehealth
Chicago, IL4 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 work
Prime Therapeutics
Saint Paul, MN4 days ago $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- ...powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service... ...outside the exam room for all patients. What You’ll Be Doing Utilization Review & Clinical Determinations Complete timely review of healthcare...Remote workBi-weekly payFull timeTemporary workFor contractorsLocal areaWork from home
Guidehealth
Rockford, IL4 days ago - ...healthcare organization is seeking a Physician Clinical Reviewer - Nephrology to join their remote team in Alabama. This role involves providing medical... ...care through detailed medical evaluation and compliance with utilization management guidelines. #J-18808-Ljbffr...Remote work
Prime Therapeutics
Montgomery, AL4 days ago - ...pharmacy benefit manager is seeking a Physician Clinical Reviewer with expertise in medical reviews and utilization management. The role involves providing timely... ...experience in a clinical setting, and must work remotely from within the United States. The position offers...Remote work
Prime Therapeutics
Oklahoma City, OK4 days ago - ...A leading pharmacy benefit management company is seeking a Physician Clinical Reviewer for a remote position. You will play a crucial role in the utilization management team by providing timely medical reviews of service requests, interacting routinely with physicians...Remote work
Prime Therapeutics
Montgomery, AL4 days ago - ...A healthcare services firm is seeking a Physician Clinical Reviewer—Nephrology, to perform remote utilization management. You will review cases in depth, discuss determinations with healthcare providers, and ensure compliance with policies. The ideal candidate has 5+...Remote work
Prime Therapeutics
Little Rock, AR4 days ago - ...A healthcare organization is seeking a Physician Clinical Reviewer for a remote opportunity. In this role, you will be a key member of the utilization management team, performing medical reviews of service requests and collaborating with physicians to ensure compliance...Remote work
Prime Therapeutics
Carson City, NV4 days ago - ...A healthcare organization is seeking a Physician Clinical Reviewer specializing in Dermatology to join their utilization management team. This remote role involves reviewing medical service requests, collaborating with healthcare professionals, and ensuring compliance...Remote work
Prime Therapeutics
Baton Rouge, LA4 days ago - ...Part-Time | Remote (U.S. Based) Medical Review Institute of America (MRIoA) is a nationally recognized leader in utilization management and clinical review services, delivering evidence-based solutions for more than Physician Advisor (Utilization Review) Part-Time | Remote...Remote workPart timeWork at officeWork from home10 hours per weekFlexible hoursShift workWeekend work
Medical Review Institute
Salt Lake City, UT4 days ago - A national medical review organization is seeking Board-Certified physicians in Neurosurgery to conduct independent Utilization Reviews. This flexible, fully remote opportunity requires only 1-2 hours per week with no minimum commitment. Candidates must hold a current medical...Remote workFlexible hours
Medical Review Institute
Dallas, TX2 days ago - ...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 work
Prime Therapeutics
Providence, RI4 days ago - 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
$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 workPrime Therapeutics
Austin, TX4 days ago$90.87 - $154.33 per hour
...A healthcare organization is seeking a Physician Clinical Reviewer specializing in Nephrology to join their remote utilization management team. The ideal candidate will have an MD, DO, or MBBS, with at least 5 years of clinical experience. Responsibilities include reviewing...Remote workPrime Therapeutics
Helena, MT4 days ago$45.9k - $102.1k
...health care service corporation in Chicago is seeking a qualified LPN for a telecommute role focused on pre-authorization reviews and utilization management. The ideal candidate will have at least 3 years of clinical experience, effective communication skills, and the...Remote workHCSC
Chicago, IL4 days ago- ...A healthcare company is seeking a remote Physician Clinical Reviewer specializing in Nephrology. The ideal candidate will have over 5 years of experience in utilization management, performing medical reviews, and providing clinical rationale for appeals. Responsibilities...Remote work
Prime Therapeutics
Denver, CO4 days ago - ...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 work
Prime Therapeutics
Tallahassee, FL4 days ago - ...healthcare organization seeks a Physician Clinical Reviewer specializing in nephrology to join their remote team. This role requires reviewing service... ...over 5 years of experience in clinical review or utilization management. If you're passionate about transforming...Remote work
Prime Therapeutics
Baton Rouge, LA4 days ago - ...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
Trenton, NJ4 days ago - ...A healthcare organization is seeking Board-Certified physicians in Oncology for a flexible, remote utilization review role. This position requires a Medical Degree (MD or DO) with a current license in Florida, Minnesota, or Oregon, and an active Board Certification in...Remote workFlexible hours
Medical Review Institute
Dallas, TX4 days ago
