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$65.5k - $96.89k
The Utilization Review Specialist will be part of our Physician Advisory Team providing first level initial admission and continued stay case reviews. The Utilization Review Specialist will determine the appropriate cases for review, utilizing client specific guidelines...Remote jobLocal areaNight shiftWeekend workDay shiftAfternoon shift- ...is looking for an experienced Registered Nurse in Peoria, Illinois. The role focuses on utilization review, clinical consultation, and effective patient support within a fully remote setting. Candidates should have an active Illinois RN license and significant...Remote workWork from home
Guidehealth
Peoria, IL18 hours ago - ...A peer review organization is seeking a full-time remote Utilization Management Physician Reviewer. Ideal candidates must hold an MD, DO, or DPM degree with active board certification and unrestricted medical license in relevant states. The role involves performing detailed...Remote workFull timeWork from home
ExamWorks
New York, NY3 days ago - ...Santa Barbara Cottage Hospital is hiring an LTC Utilization Management Reviewer for remote work in New Mexico. The role involves conducting Nursing Facility Level of Care determinations, performing utilization reviews, and ensuring services meet long-term care criteria...Remote work
Santa Barbara Cottage Hospital
New York, NY3 days ago - ...Remote Jobs are seeking a Senior Virtual Utilization Review Specialist primarily for roles in the Pacific and Mountain Time zones. The role requires a Bachelor's in Nursing and a current LPN or RN compact license. Responsibilities include conducting medical necessity reviews...Remote work
Remote Jobs
New York, NY2 days ago $275k - $300k
...~ Remote or hybrid Medical Director for MediCare service line ~100% administrative, non-clinical role ~ Work from home, but... ..., PTO ~ Requires 5+ years experience in Medicare Advantage Utilization Review/Utilization Management and an active unrestricted CA license...Remote workFull timeImmediate startWork from homeMonday to FridayInspire Healthcare
United States3 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, CA18 hours ago- A leading insurance provider in Omaha, Nebraska is seeking a full-time Utilization Review Nurse to ensure effective management of injured workers' treatments. This role does not require prior utilization review experience and is perfect for skilled nurses looking to transition...Remote jobFull timeWork at officeWork from home
$23.15 - $30.03 per hour
...members to join our corporate team! Responsibilities The Utilization review tech essentially works to coordinate the utilization review... ...will also function as an SME to support the UR tech team and remote counter parts with the specific processes as applicable. The...Remote workFull timeWork at officeLocal areaShift workPrime Healthcare
Ontario, CA4 days ago- ...Providence Health Plan Group is seeking an RN Utilization Review for a remote, per diem position in Los Angeles. You will be responsible for conducting utilization reviews across Southern California ministries and require a strong clinical background. Ideal candidates...Remote workDaily paid
Providence Health Plan Group
Los Angeles, CA3 days ago $35 - $45.94 per hour
...Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review team. About The Role You will perform frequent case... ...the Supervisor, Utilization Review. Work Location This is a remote position, open to candidates who reside in: Arizona; Florida;...Remote workHourly payFull timeWork from homeHome officeOscar Health
New York, NY3 days ago- ...Providence Health & Services is seeking an RN Utilization Review for a remote position. This per diem role includes 8-hour day shifts focused on conducting clinical reviews and utilization management for Southern California ministries. The ideal candidate will have an...Remote workDaily paidDay shift
Providence Health & Service
Irvine, CA1 day ago $60k - $75k
...support to behavioral health programs. We are looking for a Utilization Review (UR) Specialist in Boca Raton, FL Compensation: $60,000 -... ...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, FL2 hours agonew$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, NY3 days ago- ...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, IL18 hours ago $45 - $50 per hour
...Utilization Management Nurse – Medicare Remote | California RN Required | Must sit in CA We’re partnering with a mission‑driven healthcare organization... ..., concurrent, and retrospective utilization reviews for Medicare members Apply evidence‑based clinical...Remote workContract workTemporary workWork from homeActalent
Rancho Cordova, CA8 days ago- ...Paid Holidays ~ Work-life balance. ~ Remote/hybrid setting (once trained) Role Description: This individual will utilize clinical knowledge and communication skills... ...will defer decision to a second level reviewer. This individual interfaces with case managers...Remote workTemporary workWork at officeWork from homeMonday to FridayFlexible hours
Hines
Rockford, IL18 hours ago - ...possible extension) *Note: Candidates can be remote but must have an active unrestricted... ...RN License Job Summary The Clinical Reviewer, Precertification RN, is a licensed Registered... ...of the Precertification / Outpatient Utilization Management (UM) team and works under the...Remote workContract workWork at officeWork from home
AppCast
Worcester, MA2 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, IL5 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, UT18 hours ago $75k
...for a Registered Nurse (RN) to perform concurrent inpatient utilization reviews. The role requires a BSN and current nursing license, with preference... ...with health, dental, and vision benefits. The position is remote with a standard Monday-Friday schedule and a supportive work...Remote jobMonday to Friday- ...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
Peoria, IL18 hours ago - ...experienced Registered Nurse for a clinical role focusing on utilization review and care coordination. The ideal candidate will have 5+ years... ...processes, and be proficient in Microsoft 365. This role offers remote work and a comprehensive benefits package including medical,...Remote work
Guidehealth
Rockford, IL5 days ago - ...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, NY3 days ago - ...CVS Health is looking for a highly skilled Utilization Management Nurse (RN) for a remote position. In this role, you will ensure patients receive appropriate healthcare services through reviews of clinical cases and collaboration with providers. The ideal candidate will...Remote work
Freelanceshop
New York, NY1 day ago $45 - $50 per hour
...Utilization Management Nurse Medicare Remote | California RN Required | Must sit in CA We're partnering with a mission-driven healthcare organization... ..., concurrent, and retrospective utilization reviews for Medicare members Apply evidence-based clinical...Remote workContract workTemporary workWork from home- ...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...Remote work
BJC HealthCare
Kansas City, MO1 day ago - ...A healthcare administration company seeks a Utilization Management Nurse to perform medical necessity reviews while working remotely. The ideal candidate will be an active Licensed Practical Nurse (LPN) with strong proficiency in the Utilization Review process. Responsibilities...Remote work
Brighton Health Plan Solutions
Chapel Hill, NC18 hours ago - ...work from home team. This is a great opportunity for a local remote position. Schedule PRN (As needed) Shifts will fall between Monday... ...performing care for hospitalized patients. 2 years of utilization review (UR) experience reviewing hospital admissions for medical necessity...Remote workReliefLocal areaWork from homeMonday to FridayFlexible hoursShift work
BJC HealthCare
Saint Louis, MO18 hours ago $211.2k - $277.2k
...Hi, we're Oscar. We're hiring a Physician Reviewer to join our Utilization Management team. Oscar is the first health insurance company built around... ..., Utilization Management. Work Location: This is a remote position, open to candidates who reside in the United...Remote workFull timeLocal areaWork from homeHome officeWeekend workOscar Health
New York, NY2 days ago
