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$65.5k - $96.89k
...The Utilization Review Specialist will be part of our Physician Advisory Team providing first level initial admission and continued stay case reviews. The Utilization Review Specialist will determine the appropriate cases for review, utilizing client specific guidelines...Remote workLocal areaNight shiftWeekend workDay shiftAfternoon shiftR1 RCM
Boise, ID21 hours ago- ...is looking for an experienced Registered Nurse in Peoria, Illinois. The role focuses on utilization review, clinical consultation, and effective patient support within a fully remote setting. Candidates should have an active Illinois RN license and significant...Remote workWork from home
Guidehealth
Peoria, IL2 days ago - ...Santa Barbara Cottage Hospital is hiring an LTC Utilization Management Reviewer for remote work in New Mexico. The role involves conducting Nursing Facility Level of Care determinations, performing utilization reviews, and ensuring services meet long-term care criteria...Remote work
Santa Barbara Cottage Hospital
New York, NY13 hours ago - ...Remote Jobs are seeking a Senior Virtual Utilization Review Specialist primarily for roles in the Pacific and Mountain Time zones. The role requires a Bachelor's in Nursing and a current LPN or RN compact license. Responsibilities include conducting medical necessity reviews...Remote work
Remote Jobs
New York, NY3 days ago $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, CA2 days ago$23.15 - $30.03 per hour
...members to join our corporate team! Responsibilities The Utilization review tech essentially works to coordinate the utilization review... ...will also function as an SME to support the UR tech team and remote counter parts with the specific processes as applicable. The...Remote workFull timeWork at officeLocal areaShift workPrime Healthcare
Ontario, CA6 days ago$50k
...the lives of patients and their families What to Expect (Job Responsibilities) Complete pre-authorizations, concurrent reviews, and internal utilization review assessments Consult with the multidisciplinary treatment team to gather necessary information for concurrent...Remote workAdvanced Recovery Systems LLC
New York, NY13 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
- ...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 $35 - $45.94 per hour
...Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review team. About The Role You will perform frequent case... ...the Supervisor, Utilization Review. Work Location This is a remote position, open to candidates who reside in: Arizona; Florida;...Remote workHourly payFull timeWork from homeHome officeOscar Health
New York, NY13 hours ago- Ascension is seeking a Remote Registered Nurse for Utilization Management. Your vital role will involve providing healthcare services related to admissions... ...ensuring compliance with federal regulations. You will review service requests for medical necessity and assist with...Remote job
$75k
...for a Registered Nurse (RN) to perform concurrent inpatient utilization reviews. The role requires a BSN and current nursing license, with preference... ...with health, dental, and vision benefits. The position is remote with a standard Monday-Friday schedule and a supportive work...Remote jobMonday to Friday$45 - $50 per hour
...Utilization Management Nurse – Medicare Remote | California RN Required | Must sit in CA We’re partnering with a mission‑driven healthcare organization... ..., concurrent, and retrospective utilization reviews for Medicare members Apply evidence‑based clinical...Remote workContract workTemporary workWork from homeActalent
Rancho Cordova, CA9 days ago- ...Paid Holidays ~ Work-life balance. ~ Remote/hybrid setting (once trained) Role Description: This individual will utilize clinical knowledge and communication skills... ...will defer decision to a second level reviewer. This individual interfaces with case managers...Remote workTemporary workWork at officeWork from homeMonday to FridayFlexible hours
Hines
Rockford, IL2 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, IL7 days ago - ...possible extension) *Note: Candidates can be remote but must have an active unrestricted... ...RN License Job Summary The Clinical Reviewer, Precertification RN, is a licensed Registered... ...of the Precertification / Outpatient Utilization Management (UM) team and works under the...Remote workContract workWork at officeWork from home
AppCast
Lowell, MA13 hours 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, IL2 days ago - ...experienced Registered Nurse for a clinical role focusing on utilization review and care coordination. The ideal candidate will have 5+ years... ...processes, and be proficient in Microsoft 365. This role offers remote work and a comprehensive benefits package including medical,...Remote work
Guidehealth
Rockford, IL7 days ago - ...leading healthcare solutions company is seeking an experienced Utilization Review Nurse to improve patient care through home-based services.... ...accredited nursing degree and experience in utilization review. Competitive pay and remote flexibility offered. #J-18808-Ljbffr...Remote work
Medix
New York, NY13 hours ago - 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 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
Kansas City, MO3 days ago - ...NeuroPsychiatric Hospitals is seeking a Utilization Review Nurse (RN) to coordinate patient services across multiple hospitals. The role supports... ...collaborating with teams for better outcomes. Located remotely with a preference for candidates in Indiana, Michigan, or...Remote work
NeuroPsychiatric Hospitals
Indiana, PA3 days ago - ...CVS Health is looking for a highly skilled Utilization Management Nurse (RN) for a remote position. In this role, you will ensure patients receive appropriate healthcare services through reviews of clinical cases and collaboration with providers. The ideal candidate will...Remote work
Freelanceshop
New York, NY2 days ago - ...Santa Barbara Cottage Hospital is hiring a Utilization Review Nurse for a remote position. The role involves gathering clinical information, certifying medical necessity, and making decisions on treatment certifications. Ideal candidates will have a strong nursing background...Remote work
Santa Barbara Cottage Hospital
New York, NY13 hours 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 - ...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 - ...Registered Nurse – Utilization Review (Remote) This is a fully remote Utilization Review RN role supporting multiple service lines and levels of care, including Inpatient, Extended Hospital Outpatient, and Observation (OBS). Position Overview: This is a fully...Remote work
3B Healthcare, Inc.
United States4 days ago - ...looking for a dedicated professional to join their Utilization Management team. The role involves conducting reviews and evaluations for members needing... ...years of relevant experience. The job is primarily remote but may require occasional office visits. Candidates...Remote workWork at office
Central Health
Austin, TX1 day ago - ...Santa Barbara Cottage Hospital is seeking an RN for Utilization Review, a Per Diem position working remote 8-hour day shifts. This role includes conducting clinical reviews and utilization assessments for our Southern CA ministries. Candidates should have an Associate...Remote workDaily paidDay shift
Santa Barbara Cottage Hospital
New York, NY2 days ago - ...A healthcare services provider is seeking a Remote Utilization Review Nurse to coordinate clinical resources, ensuring compliance with healthcare standards. Responsibilities include processing authorizations, reviewing documentation, and collaborating with teams to meet...Remote workContract work
IntePros
New York, NY13 hours ago
