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$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- A leading claims management company is seeking a Utilization Review Coordinator. The role requires experience in administrative support and knowledge of medical terminology. Responsibilities include assigning utilization review requests, data entry, and providing support...Remote jobFull time
- 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
$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 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
- A leading independent review organization is seeking a Board-Certified Chiropractor for a flexible, fully remote opportunity involving independent Utilization Reviews. The role requires a Chiropractic Degree, a Missouri state license, and 5 years of clinical experience...Remote jobFlexible hours
- ...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 - A healthcare organization in Washington D.C. is seeking a Clinical Utilization Review Nurse (RN) for a remote position. This full-time PRN role involves assessing medical necessity and quality of healthcare services through utilization reviews. The ideal candidate will...Remote jobFull timeReliefWeekend workAfternoon shift
- ...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 $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- ...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 - ...seeking a Full-Time Clinical Supervisor to lead clinical and utilization reviews. The successful candidate will have a strong background in... ...thinking, and team management. The position may also allow for remote or hybrid work arrangements. The organization offers...Remote workFull time
- 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
- ...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 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 - ...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 - ...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 - ...Experience by Specialty Pediatrics* ICU MS Case Management/Utilization Review Pre-Cert Review* Prior Authorizations* Retrospective... ...Commission/ Core Measure/National Safety Goals Additional Skills remote UR work CA and Medi-Cal experience/knowledge*Remote work
B2B Staffing Services
Torrance, CA3 days ago - ...A recognized Independent Review Organization is seeking Board-Certified Orthopedic Spine Surgeons for a remote Physician Reviewer role. This non-clinical position focuses on conducting utilization reviews without direct patient interaction. Responsibilities include reviewing...Remote workExtra incomeFlexible hours
Dane Street
New York, NY4 days ago - ...is seeking an experienced Medical Director to conduct clinical reviews and guide decision-making in inpatient care. The role... ...of clinical experience, with a focus on hospital medicine and utilization review. Join a distinguished team to impact patient outcomes while...Remote work
Humana
Columbus, OH4 days ago $56.44 - $87.63 per hour
...A leading healthcare organization is seeking an RN for Utilization Review who can manage both prospective and concurrent reviews while working remotely. Key responsibilities include conducting clinical reviews and navigating a fast-paced regulatory environment. Candidates...Remote workHourly payDaily paidProvidence Service
Irvine, CA4 days ago- ...A healthcare management firm is seeking a Physician Reviewer to join their remote team. The role involves performing real-time case reviews and... ...The position offers flexibility and requires knowledge in utilization management and experience with Medicare and Medicaid. #J-...Remote work
Tango
Phoenix, AZ4 days ago - ...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 workWork from home
Prime Therapeutics
Salt Lake City, UT4 days ago - ...A leading healthcare company is seeking a Medical Director to perform clinical reviews and assess medical necessity for inpatient cases. This role offers the chance to collaborate with a team of physicians, making a significant impact on patient care. Requires an MD/DO...Remote workWork from home
Humana
Providence, RI4 days ago $90.87 - $154.33 per hour
...healthcare organization seeks a Physician Clinical Reviewer in Gastroenterology to provide medical review for service requests remotely. Candidates should have 5+ years of... ...patient care and work collaboratively in a utilization management team while enjoying a competitive...Remote workPrime Therapeutics
Saint Paul, MN4 days ago- A leading healthcare organization is seeking a Registered Nurse Utilization Manager (RNUM) for a fully remote position based in Phoenix, Arizona. The role involves reviewing cases, educating patients about appropriate care, and managing healthcare costs for dependents of...Remote jobWork at office
$223.8k - $313.1k
...A leading U.S. healthcare company seeks a Medical Director to conduct inpatient medical necessity reviews. This role requires an MD or DO with over 5 years of clinical experience. Responsibilities include performing clinical assessments, collaborating with a multidisciplinary...Remote workWork from homeHumana
Dover, DE4 days ago- ...A leading medical review organization is seeking Board‑Certified physicians in Pediatric Hematology Oncology for flexible, remote Utilization Reviews. This role requires conducting independent reviews of pediatric cases, engaging in peer-to-peer discussions, and ensuring...Remote workPart timeFlexible hours
Medical Review Institute
Dallas, TX4 days ago
