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$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- 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
- 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 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
- 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
$275k - $300k
...~ Remote or hybrid Medical Director for MediCare service line ~100% administrative, non-clinical role ~ Work from home, but... ..., PTO ~ Requires 5+ years experience in Medicare Advantage Utilization Review/Utilization Management and an active unrestricted CA license...Remote workFull timeImmediate startWork from homeMonday to FridayInspire Healthcare
United States1 day 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, IL3 days ago - 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 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 $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 jobContract work- 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
$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- ...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 States2 days 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
- ...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, IL3 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
Philadelphia, PA6 days ago- ...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
- ...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 - A healthcare provider is seeking a Utilization Review Nurse to coordinate resources and ensure efficient delivery of home health care. This role involves monitoring patient admissions and ongoing care while ensuring adherence to guidelines. The ideal candidate will have...Remote workContract work
IntePros
Phoenix, AZ2 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...Remote workFlexible hours
Medical Review Institute
Dallas, TX1 day 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 - 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, MS3 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, VA2 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, CA2 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, NJ3 days 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, TX3 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 - ...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, OH3 days ago $223.8k - $313.1k
...organization is seeking a Medical Director in Jefferson City, Missouri. The role involves conducting clinical reviews of inpatient records and making utilization management determinations. Candidates should possess an MD or DO, an active medical license, and at least 5...Remote workHumana
Jefferson City, MO3 days ago
