Get new jobs by email
- ...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 workFull timeWork from home
Hispanic Alliance for Career Enhancement
Chicago, IL3 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, CA1 day ago $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, TX1 day 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 work
Guidehealth
Chicago, IL3 days ago - ...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...Remote work
Guidehealth
Saint Louis, MO3 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 work
Guidehealth
Milwaukee, WI3 days ago - ...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, IL3 days 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
Peoria, IL3 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 work
Prime Therapeutics
Saint Paul, MN3 days ago - ...Part-Time | Remote (U.S. Based) Medical Review Institute of America (MRIoA) is a nationally recognized leader in utilization management and clinical review services, delivering evidence-based solutions for more than Physician Advisor (Utilization Review) Part-Time | Remote...Remote workPart timeWork at officeWork from home10 hours per weekFlexible hoursShift workWeekend work
Medical Review Institute
Salt Lake City, UT3 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, NV3 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, AR3 days ago - ...Depending on business needs and individual circumstances, **remote or hybrid work arrangements may be available** for qualified... ...candidates.* **Required Work Experience:** 5 years clinical and utilization review to include 2 years supervisory or team lead experience or...Remote workFull timeWork experience placementWork at officeMonday to Friday
Southcarolinablues
Nashville, TN2 days ago - ...A leading pharmacy benefit manager is seeking a Physician Clinical Reviewer - Nephrology to join their remote utilization management team. This role involves reviewing clinical cases for medical necessity, collaborating with healthcare professionals, and maintaining documentation...Remote work
Prime Therapeutics
Lansing, MI3 days ago $90.87 - $154.33 per hour
...A healthcare services company seeks a Physician Clinical Reviewer - Nephrology to join their utilization management team. This remote role requires reviewing service requests, interacting with physicians, and ensuring compliance with medical necessity guidelines. Candidates...Remote workPrime Therapeutics
Jackson, MS3 days ago- ...or LPN/LVN compact license and have experience in clinical reviews and utilization management. Responsibilities include drafting clinical correspondence... ...benefits package, with flexible work arrangements available including remote and hybrid options. #J-18808-Ljbffr...Remote workFlexible hours
Centene Corporation
Columbia, SC4 days ago - ...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, LA3 days ago - ...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, OK3 days 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, AL3 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, NV3 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, TN3 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, AL3 days ago - A national medical review organization is seeking Board-Certified physicians in Neurosurgery to conduct independent Utilization Reviews. This flexible, fully remote opportunity requires only 1-2 hours per week with no minimum commitment. Candidates must hold a current medical...Remote workFlexible hours
Medical Review Institute
Dallas, TX1 day 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, NJ3 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, FL3 days ago - ...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 work
Prime Therapeutics
Baton Rouge, LA3 days ago $90.87 - $154.33 per hour
...A leading pharmacy benefits manager is seeking a Physician Clinical Reviewer - Nephrology to join their utilization management team. The role is remote and requires a DO, MBBS, or MD. Candidates should have over 5 years of experience in medical reviews and be adept at...Remote workPrime Therapeutics
Lincoln, NE3 days ago$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 workPrime Therapeutics
Oklahoma City, OK3 days ago- ...organization is seeking a Physician Clinical Reviewer for Nephrology, requiring a medical degree (DO, MBBS, MD). This remote role involves reviewing clinical cases,... ...professionals, and ensuring compliance with utilization management guidelines. Ideal candidates should...Remote work
Prime Therapeutics
Phoenix, AZ3 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, CA2 days ago
