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- ...Cincinnati Children's is seeking a Utilization Review professional to perform admission and continued stay reviews to determine medical necessity... ...requires RN licensure with relevant experience and works remotely in the United States. The position includes interactions...Remote work
CO00 Children's Hospital Medical Center
New York, NY3 days ago - Spectrum Billing Solutions is seeking an ABA Utilization Review Specialist to review clinical data and obtain authorized services for ABA and related treatments. This role offers either remote work or a home-office hybrid setup, with collaboration across clinical staff...Remote jobWork from homeHome office
- Banner Health seeks an experienced RN for Utilization Review in a fully remote role with hybrid onsite expectations. You will review clinical information and audits of billings to ensure appropriate care and billing aligns with payor terms across Banner facilities. Requires...Remote jobWork from homeFlexible hours
- ...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
- ...and next steps. Our partner is looking for a Case Manager - Utilization Review Specialist based in the United States. Join a healthcare team... ...ensuring compliance with clinical and payer requirements. In this remote role, you will oversee admission and concurrent utilization...Remote workFull timeLive in
- ...Optum is seeking a Behavioral Health Utilization Review Specialist to support case management and care coordination remotely. You will review cases, determine levels of care, and coordinate transitions between inpatient and outpatient settings. You will collaborate with...Remote workMonday to Friday
Optum
Phoenix, AZ5 days ago $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- ...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, NY4 days 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.
California2 hours ago - ...Arkansas Blue Cross Blue Shield is seeking an experienced Utilization Management Nurse to perform clinical reviews for prior approvals, benefit inquiries, and inpatient/outpatient services. This role requires interpreting evidence-based criteria, guidelines, and policies...Remote workWork from home
Arkansas Blue Cross
Idaho Falls, ID2 days ago - ...Integrated Management Strategies (IMS) is seeking an experienced Sr Review Coordinator to join our healthcare consulting practice. This role is fully remote within the US and focuses on utilization review of plans of service for home and community-based programs, impacting...Remote workContract workWork from home
Integrated Management Strategies
New York, NY2 days ago - Diversified Treatment Alternative Centers (DTAC) is seeking a detail-oriented Utilization Review (UR) Specialist to support our behavioral health programs in a hybrid/remote setup in Chadds Ford, PA. You will manage authorizations and eligibility verification across clinical...Remote job
$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, CA1 day 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, NY5 days ago - ...WNS, part of Capgemini, seeks a remote Utilization Review Nurse to perform medical necessity reviews and collaborate with providers to ensure compliant patient care. The role emphasizes adherence to HIPAA, state and federal regulations, and a strong team-oriented environment...Remote workWork at office
HealthHelp
New York, NY1 day ago - ...Remote Drug Utilization Review PharmacistRemote DUR Pharmacist – Safe & Cost-Effective Medication Use | Work From Home Analyze medication use patterns, apply clinical guidelines, and collaborate with providers — all from home. This remote Drug Utilization Review Pharmacist...Remote workWork from home
Pharmacy Careers
Honolulu, HI5 days ago - ...Utilization Review AnalystUtilization Review Analyst conducts prospective, concurrent, and retrospective reviews of service authorizations,... ...which may occur outside of standard office hours. Hybrid (onsite/remote) work schedule available. The ideal candidate must be able to...Remote workWork at office
Oakland Community Health Network
Troy, MI4 days ago - ...Gainwell Technologies LLC is seeking a Senior Nurse Reviewer to perform reviews of medical records, healthcare claims, itemized medical... ...expertise and itemized bill review experience, with potential utilization review responsibilities. Home-based position within the...Remote workWork from homeFlexible hours
Gainwell Technologies LLC
Columbus, OH5 days ago $40k - $50k
...Description Utilization Review Specialist Full-Time- must be able to work a few weekends per month Location: Remote Preferred Residence: Candidates residing in Florida, Tennessee, Texas, Virginia, South Carolina, or New Jersey are strongly encouraged to apply. Job Details...Remote workFull timePart timeWork at officeWeekend workRecovery Unplugged
Fort Lauderdale, FL5 days ago- ...Saint Joseph Health System is seeking an RN Utilization Review specialist for a part-time, remote PRN role that requires on-site training in Mishawaka, Indiana. The position emphasizes reviewing medical necessity, insurance requirements, and discharge planning in collaboration...Remote workPart timeRelief
Trinity Health
Mishawaka, IN4 days ago - Spectrum Billing Solutions is seeking an ABA Utilization Review Specialist. The role supports review of clinical data to determine medical necessity... ...authorizations for ABA and related services. It is a fully remote or office/home hybrid position with a collaborative, detail-...Remote jobWork at office
- ...Corporation is seeking a licensed clinician to review ABA services and health status across... ...reviews, data analysis to improve utilization, and collaboration with BH providers. Time... ...MST, or CST is required, with flexible remote/hybrid options. #J-18808-Ljbffr Centene...Remote workFlexible hours
- FHE Health in the United States seeks an experienced Utilization Review Specialist to manage clinical authorization processes, ensuring timely, accurate, and compliant communications with insurance payers. You will support patient access by securing initial and continued...Remote job
- American Health Holding, Inc. (an division of CVS Health) is seeking a Utilization Management Nurse Consultant specializing in Medical Review. This fully remote role emphasizes precise clinical review, collaboration with providers, and compassionate patient care in a fast...Remote job
- Kent County Cmh Authority is seeking a Utilization Review Specialist to perform reviews for I/DD, mental health, and SUD services. You will assess... ...to appropriate intensity settings. The role is full-time and remote with occasional local travel within the Kent County area....Remote jobFull timeLocal area
$65k - $85k
...Concierge Home Care | Remote Opportunity | Growth Opportunities | Increased Earning Potential At Concierge Home Care, we are growing and looking for an experienced Utilization Review Specialist (RN) to join our remote home health team. This role is ideal for an RN with...Remote workMonday to FridayWeekend workWeekday workConcierge Home Care
Jacksonville, FL1 day ago- EK Health Services Inc. is hiring for a Utilization Review healthcare professional in a remote, full-time capacity. The UR HCP applies clinical knowledge to assess the medical necessity of provider requests and uses evidence-based guidelines appropriate to the jurisdiction...Remote jobFull time
- ...-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
santacruzcountyca.gov
Santa Cruz, CA2 days ago - ...Cincinnati Children e s Hospital Medical Center is seeking a Remote Utilization Review professional to perform admission and continued stay reviews using InterQual, ensuring medical necessity and appropriate level of care. The role collaborates with Admitting, Financial...Remote work
Cincinnati Children's Hospital Medical Center
Cincinnati, OH2 hours ago $219k - $286.9k
...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 work
