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- 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
$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, TX10 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
- 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, IL2 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
- ...Provides support for clinical member services review assessment processes. Responsible for... ...the Molina care model. • Adheres to utilization management (UM) policies and procedures.... ...SharePoint Fast learner Remote work experience Must obtain NV RN Licensure...Remote workWork experience placementWork at office
Molina Healthcare
United States1 day ago - ...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, IL2 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- 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
- ...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
- ...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, LA2 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, FL2 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, AL2 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, NV2 days ago - ...Registered Nurse Utilization Review (Remote) Contract Length: 13 Weeks (Extension Possible) Facility: Providence Medical Center Location: 4101 Torrance Blvd, Torrance, CA 90503 Shift: Days 5x8-Hour (08:00 AM 04:30 PM) Schedule: 40 hours per week Weekend...Remote workContract workShift work
3B Healthcare, Inc.
Torrance, CA1 day ago - Humana is offering a Utilization Management Behavioral Health Registered Nurse (RN) Internship for transitioning military service members... ...and military spouses. This role involves conducting clinical reviews, communicating with healthcare providers, and ensuring documentation...Remote workInternship
Humana
Jackson, MS1 day 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, TX2 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, NJ2 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, CA1 day 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, MN2 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, NY2 days ago - Humana is seeking a Utilization Management Behavioral Health Registered Nurse (RN) Intern. The role is primarily remote, emphasizing clinical reviews of authorization requests and coordination with healthcare teams. Applicants must be transitioning military members or spouses...Remote workInternship
Humana
Manchester, NH1 day 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, OH2 days ago - ...A recognized Independent Review Organization is seeking a Board-Certified Psychiatrist for a fully remote role conducting Utilization Reviews. Candidates should have an active New York medical license and Workers’ Compensation Board Certification. Responsibilities include...Remote workExtra incomeFlexible hours
Dane Street
New York, NY2 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, TX2 days ago - A healthcare solutions company is seeking a Clinical Reviewer - LPN/LVN or RN for a remote role in the U.S. Responsibilities include reviewing medical... ...an active license, with 2+ years of experience in Utilization Review. The role requires strong clinical assessment skills...Remote workShift work
Acentra Health
McLean, VA1 day 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, AZ2 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, UT2 days ago
