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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$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 States22 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 - ...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 - ...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 States1 day 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
Rockford, IL2 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, PA5 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 - ...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, CA1 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, NV2 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, TX22 hours 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, TX2 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, NJ2 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, MS2 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, FL2 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, VA1 day 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, CA1 day ago - Humana is seeking a Utilization Management Behavioral Health Registered Nurse (RN) Intern. The role is primarily remote, emphasizing clinical reviews of authorization requests and coordination with healthcare teams. Applicants must be transitioning military members or spouses...Remote workInternship
Humana
Manchester, NH2 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, OH2 days ago - ...A healthcare management firm is seeking a Physician Reviewer to join their remote team. The role involves performing real-time case reviews and... ...The position offers flexibility and requires knowledge in utilization management and experience with Medicare and Medicaid. #J-...Remote work
Tango
Phoenix, AZ2 days ago $65.5k - $96.89k
...advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. The Utilization Review Specialist will be part of our Physician Advisory Team providing first level initial admission and continued stay case...Local areaNight shiftWeekend workDay shiftAfternoon shiftR1 RCM
Chicago, IL4 days ago- ...A leading medical review organization is seeking Board‑Certified physicians in Pediatric Hematology Oncology for flexible, remote Utilization Reviews. This role requires conducting independent reviews of pediatric cases, engaging in peer-to-peer discussions, and ensuring...Remote workPart timeFlexible hours
Medical Review Institute
Dallas, TX2 days ago - ...A recognized Independent Review Organization is seeking a Board-Certified Psychiatrist for a fully remote role conducting Utilization Reviews. Candidates should have an active New York medical license and Workers’ Compensation Board Certification. Responsibilities include...Remote workExtra incomeFlexible hours
Dane Street
New York, NY2 days ago - A health services provider is seeking a Utilization Review Specialist in Malibu, CA. This part-time remote role requires effective communication skills and knowledge of medical terminology. Responsibilities include managing cases for clients in treatment and ensuring compliance...Remote workPart time
MALIBU GROUP LLC
Malibu, CA2 days ago $223.8k - $313.1k
...A leading U.S. healthcare company seeks a Medical Director to conduct inpatient medical necessity reviews. This role requires an MD or DO with over 5 years of clinical experience. Responsibilities include performing clinical assessments, collaborating with a multidisciplinary...Remote workWork from homeHumana
Dover, DE2 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, MO2 days ago- ...A leading healthcare company is seeking a Medical Director to perform clinical reviews and assess medical necessity for inpatient cases. This role offers the chance to collaborate with a team of physicians, making a significant impact on patient care. Requires an MD/DO...Remote workWork from home
Humana
Providence, RI2 days ago - ...A leading medical review company in Washington is seeking a Utilization Management Nurse Reviewer. The role involves assessing medical necessity, reviewing patient... .... The position offers a competitive salary range, remote work options, and a comprehensive benefits package...Remote work
Dane Street
Washington DC2 days ago $223.8k - $313.1k
...seeking a Medical Director to provide expert clinical reviews and advance patient outcomes. This remote position emphasizes collaboration and structured... ...abilities. Join a dedicated team focused on effective utilization management while enjoying a competitive compensation...Remote workHumana
Springfield, IL2 days ago
