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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, ID2 days 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, IL3 days ago - ...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, AK3 days ago $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, CA23 hours ago- ...Essential Duties and Responsibilities Performs utilization review in accordance with all state mandated regulations Analyzes insurance, governmental and accrediting standards to determine criteria concerning admissions, treatment, and length of stay Assures compliance...Remote workWeekly payContract workWork at officeLocal area
Amergis
Baltimore, MD5 days ago - Council of State and Territorial Epidemiologists is hiring a Clinical Utilization Review Nurse (RN) to work remotely while assessing the medical necessity of healthcare services. This role requires an active RN license in Alabama and a minimum of 3 years direct patient...Remote jobWork from home
- 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
- The Council of State and Territorial Epidemiologists is seeking Clinical Utilization Review Nurses (RN) based in Alabama for a remote, full-time position. This role involves assessing the medical necessity of healthcare services and ensuring compliance with Alabama Medicaid...Remote jobFull timeWork from home
- ...The Council of State and Territorial Epidemiologists seeks a Clinical Utilization Review Nurse (RN) for a full-time remote role assessing healthcare service necessity and quality. This position requires an active RN license in Alabama and a BA/BS in Nursing, along with...Remote workFull time
Council Of State and Territorial Epidemiologists
Albuquerque, NM2 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, CA2 days ago- 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
- ...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 - New-Freedom-Ops-LL in Phoenix, AZ is looking for a Utilization Review Specialist to oversee utilization review activities across behavioral health care. Responsibilities include conducting reviews, ensuring compliance with regulations, and liaising with clinical staff...Remote job
- ...nights! * 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 and Associates
Rockford, IL11 hours 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 $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- ...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, IL3 days ago $65k - $78k
...career in a company that values work-life balance, continuous learning, and career development. Summary We are seeking a skilled Utilization Review Nurse to conduct prior authorization, prospective, concurrent, and retrospective reviews for medical necessity and...Remote workFull timeContract workWork at officeWork from homeFlexible hoursGainwell Technologies
Juneau, AK3 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
- ...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 $250k
...Family Medicine physician to join our team in a non-clinical utilization review role. Opportunity Highlights ~ Work schedule is Monday to... ...Friday during daytime hours, with the possibility of partial remote work. ~ Robust Clinical Documentation Improvement (CDI)...Remote workMonday to FridayEnterprise Medical Services
Maryland5 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...Remote work
3B Healthcare, Inc.
Torrance, CA1 day ago $68.04k - $118.8k
EmblemHealth is seeking a Care Manager for Concurrent Review in New York, NY. This remote position requires a nursing degree and a valid RN License... ...4-6 years of nursing experience in case management or utilization management. The selected candidate will perform clinical...Remote job- ...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 administration company seeks a Utilization Management Nurse to perform medical necessity reviews while working remotely. The ideal candidate will be an active Licensed Practical Nurse (LPN) with strong proficiency in the Utilization Review process. Responsibilities...Remote work
Brighton Health Plan Solutions
Chapel Hill, NC3 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
Kansas City, MO4 days ago $60.2k - $107.4k
...Stryker Corporation is seeking a Utilization Review Nurse, RN, responsible for managing inpatient utilization efficiently while applying evidence... ...Management skills. The position allows flexibility to work remotely across the U.S., offers a competitive salary range of $60,20...Remote workStryker
Sacramento, CA3 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- ...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 - ...The Council of State and Territorial Epidemiologists is seeking a Clinical Utilization Review Nurse (RN) for a remote position focused on assessing healthcare services for medical necessity. Candidates must hold an active RN license in Alabama and have at least 3 years...Remote work
Council Of State and Territorial Epidemiologists
Sacramento, CA11 hours ago
