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- ...A leading healthcare solutions company seeks a skilled Utilization Review Nurse to conduct vital reviews for medical necessity and appropriateness. The ideal candidate will have an active RN license, 3+ years of inpatient clinical experience, and strong written communication...Remote workWork from homeFlexible hours
Gainwell Technologies
Juneau, AK2 days ago - ...A healthcare organization is looking for a Utilization Management RN in Mission Hills, California, to provide prospective, retrospective, and concurrent reviews for ministries. Candidates should have strong clinical skills, a nursing degree, and California RN license....Remote work
Providence Service
Mission Hills, CA7 hours 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
- 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
- ...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, 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- ...IMLCC. ABOUT MRIoA Founded in 1983, Medical Review Institute of America (MRIoA) is a... ...(IRO) specializing in technology-driven utilization management and clinical medical review solutions... ...case requirements Additional Details Remote, work-from-home position—work anywhere...Remote workFor contractorsWork from homeFlexible hours
Medical Review Institute
Orlando, FL2 days ago $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- ...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
- 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 healthcare organization is seeking an experienced RN Case Manager with a strong background in UAS assessments and utilization review. This fully remote position emphasizes data-driven decision-making to ensure appropriate care. Responsibilities include reviewing UAS assessments...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
- ...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 - ...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
- ...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 work
Prime Therapeutics
Saint Paul, MN2 days ago $76k - $85k
...A leading public sector solutions firm is hiring a Utilization Review Nurse in Idaho Falls. This role entails performing prior authorization... ...offers a competitive salary range of $76,000 - $85,000 and is remote. Strong communication and organizational skills are essential...Remote workPublic Consulting Group
Idaho Falls, ID2 days ago- ...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
- ...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 work
Prime Therapeutics
Oklahoma City, OK2 days ago - ...healthcare provider in Los Angeles is seeking a Utilization Management RN responsible for conducting clinical reviews and overseeing medical records for admission. Candidates... ...RN license, and two years of experience in a remote utilization review environment or as an acute...Remote work
Providence Health Plan Group
Los Angeles, CA7 hours ago - ...healthcare organization is seeking a Physician Clinical Reviewer - Nephrology to join their remote team in Alabama. This role involves providing medical... ...care through detailed medical evaluation and compliance with utilization management guidelines. #J-18808-Ljbffr...Remote work
Prime Therapeutics
Montgomery, AL2 days ago $90.87 - $154.33 per hour
...A pharmacy benefit management company is seeking a Physician Clinical Reviewer (Nephrology) for a remote role. The successful candidate will be part of the utilization management team, conducting medical reviews and working closely with physicians and management staff....Remote workPrime Therapeutics
Nashville, TN2 days ago$76k - $85k
...A leading public sector solutions firm is seeking a Remote Utilization Review Nurse to perform prior authorizations and reviews based on clinical documentation. The role requires an Associate's or Bachelor's degree in Nursing, a valid RN license, and a minimum of two years...Remote workPublic Consulting Group
Montgomery, AL2 days ago- ...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
Des Moines, IA2 days ago - ...A healthcare services firm is seeking a Physician Clinical Reviewer—Nephrology, to perform remote utilization management. You will review cases in depth, discuss determinations with healthcare providers, and ensure compliance with policies. The ideal candidate has 5+...Remote work
Prime Therapeutics
Little Rock, AR2 days ago $90.87 - $154.33 per hour
...A leading healthcare organization is seeking a Physician Clinical Reviewer - Cardiology to join their remote utilization management team. The role involves reviewing clinical cases, interacting with physicians, and ensuring compliance with medical guidelines. Candidates...Remote workPrime Therapeutics
Carson City, NV2 days ago$90.87 - $154.33 per hour
...A healthcare organization is seeking a Physician Clinical Reviewer for their utilization management team. This remote position is focused on cardiology and involves reviewing clinical cases that need medical necessity evaluations. Candidates should hold a DO, MBBS, or...Remote workPrime Therapeutics
Maryland2 days ago$90.87 - $154.33 per hour
...company in Michigan is seeking a Physician Clinical Reviewer - Cardiology to join their utilization management team. The role entails reviewing medical service... ...a range of pay from $90.87 to $154.33 based on experience, and provides a remote work option. #J-18808-Ljbffr...Remote workPrime Therapeutics
Lansing, MI2 days ago$90.87 - $154.33 per hour
...A healthcare company is seeking a Physician Clinical Reviewer - Dermatology to join their utilization management team. This remote position involves reviewing medical service requests, interacting with physicians, and providing clinical justifications for appeals. The...Remote workPrime Therapeutics
Austin, TX2 days ago$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 workPrime Therapeutics
Indianapolis, IN2 days ago$76k - $85k
...A leading public sector solutions firm is seeking a Utilization Review Nurse to perform reviews, use medical management software, and ensure quality care. This remote role requires an RN, along with a minimum of 2 years’ clinical nursing experience and proficiency in...Remote workPublic Consulting Group
Salt Lake City, UT2 days ago
