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$275k - $300k
...Remote or hybrid Medical Director for MediCare service line 100% administrative, non-clinical role Work from home, but candidate... ...CME, PTO Requires 5+ years experience in Medicare Advantage Utilization Review/Utilization Management and an active unrestricted CA license...Remote workPermanent employmentFull timeWork from homeMonday to FridayIntegrity Healthcare
Sacramento, CA3 days ago- 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 jobFull timeWork from home
- ...agency in Arizona seeks a Behavioral Health Prior Authorization Utilization Review Consultant. The role involves monitoring and evaluating... ...three years of healthcare experience. The position may offer remote work flexibility within Arizona, contributing to a supportive...Remote job
- ...insurance firm in Warwick seeks a UM Specialist to handle medical review decisions, balancing clinical standards with excellent... ...Responsibilities include reviewing medical services and conducting utilization reviews. Ideal candidates have an Associate's degree and three...Remote jobFlexible hours
- A leading healthcare organization in California is seeking an RN Utilization Review professional for a full-time remote role. The position entails conducting utilization reviews and managing a varied workload in a fast-paced environment. Required qualifications include...Remote jobFull time
$18 - $20 per hour
...using evidence-based practices to help families heal. As our Utilization Review Specialist, you will be responsible for maintaining organizational... ...psychiatric and behavioral health services. This fully remote role requires strong clinical judgment, payor communication skills...Remote workFull timeHome office$29.95 - $44.77 per hour
A national risk management firm is seeking a Utilization Review Case Manager to analyze clinical information for patient admissions and treatment. This remote position requires strong CPT and ICD coding knowledge, along with effective organizational and communication skills...Remote jobHourly pay- ...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 job
- ...high-quality care through efficient medical resource utilization. Key responsibilities include reviewing medical records and collaborating with healthcare... ...areas and utilization review. The role supports both remote work and in-person collaboration, ensuring exceptional...Remote job
- ...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 GuidehealthRemote job
- ...emphasizes high-quality patient-centered care through detailed Utilization Review. Responsibilities include managing healthcare service... ...and over 5 years of relevant experience. The position is fully remote, offering competitive benefits including medical, dental, and...Remote job
- .... ABOUT MRIoA Founded in 1983, Medical Review Institute of America (MRIoA) is a nationally... ...(IRO) specializing in technology‑driven utilization management and clinical medical review... ...case requirements Additional Details Remote, work‑from‑home position—work anywhere...Remote workFor contractorsWork from homeFlexible hours
$28.41 - $43.47 per hour
...) Department Coordinate and execute the review and research functions required to support... ...Health Plan is calling an Associate Utilization Review Specialist who will: Be responsible... ..., etc.) This position offers 100% remote work for candidates residing in Portland...Remote jobMinimum wageFull timeWork experience placementShift work- ...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, CA10 hours ago - ...Manager to advance high-quality, patient-centered care through Utilization Review. The ideal candidate will have an active RN license in... ...healthcare services and coordinating care effectively. This fully remote position offers flexibility, competitive pay, and comprehensive...Remote job
$35 - $45.94 per hour
Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review team. Oscar is the first health insurance company built... ...the Supervisor, Utilization Review. Work Location: This is a remote position, open to candidates who reside in: Texas, Georgia,...Remote workHourly payFull timeWork from homeHome office- ...elevate outcomes, and love your Mondays as the Nurse Director Utilization Review and Case Management at an award winning hospital in the Bay... ...imaging, AI-assisted decision support, virtual nursing, and remote monitoring; clear investment in clinician well-being through...Remote workWeekend work
Clinical Management Consultants
Berkeley, CA3 days ago - ...Dane Street, a nationally recognized Independent Review Organization (IRO), is expanding its panel of Physician Reviewers... ...Workers’ Compensation Board Certification to conduct Utilization Reviews. This is a fully remote, non-clinical role offering supplemental income with...Remote workPrice workExtra incomeFor contractorsFlexible hours
Dane Street
United States1 day ago $33.6 - $51.39 per hour
...work-from-home team! This is a great opportunity for a local remote position. There is no communication with patients. This position... ...performing care for hospitalized patients ~2 years of Utilization Review (UR) experience reviewing hospital admissions for medical necessity...Remote workHourly payFull timeWork experience placementReliefLocal areaWork from homeMonday to FridayFlexible hoursShift workBJC HealthCare
Saint Louis, MO2 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 job
$90.87 - $154.33 per hour
...healthcare management company is hiring a Physician Clinical Reviewer specializing in Cardiology on a remote basis. The ideal candidate must hold an MD, DO, or... ...based on experience. This role is essential to the utilization management team, focusing on patient-centered care....Remote job- ...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 job
- A leading healthcare company is seeking a Physician Clinical Reviewer - Cardiology to join their utilization management team. This remote role involves medical reviews of service requests and interaction with various healthcare professionals. Candidates should have a DO...Remote job
- ...pharmacy benefit manager is seeking a Physician Clinical Reviewer - Nephrology for a remote position. The ideal candidate will have a medical... ...and over 5 years of clinical experience, focusing on the utilization management process. Responsibilities include conducting...Remote job
- A healthcare organization is seeking a Physician Clinical Reviewer specializing in Cardiology to join their remote utilization management team. The ideal candidate will review service requests, consult with healthcare providers on clinical determinations, and ensure compliance...Remote job
- ...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 job
$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 job$60.2k - $107.4k
A leading healthcare organization seeks a Utilization Review Nurse, RN to join their team in Albuquerque, NM. This role involves overseeing inpatient... ...RN license and relevant experience. The position allows for remote work flexibility across the U.S. and offers a competitive...Remote job$90.87 - $154.33 per hour
A healthcare company is seeking a Physician Clinical Reviewer specializing in Ophthalmology for a remote position. The candidate will play a crucial role in the utilization management team, providing timely medical review of service requests. The role requires a DO, MBBS...Remote job- ...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 job
