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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 shift- ...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
- ...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
- ...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
- ...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
$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 Friday$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 work- ...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
- ...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
- ...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
- ...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
$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 hours$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 Friday- ...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
- ...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
$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 work- ...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
- ...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
- ...COMAGINE HEALTH is seeking Clinical Utilization Review Nurses (RN) for a full-time remote position focused on assessing the medical necessity of healthcare services in Alabama. Candidates must hold an active RN license and possess a BA/BS in nursing, alongside a minimum...Remote workFull time
- ...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
- ...Case Management Senior Analyst Location: Remote Schedule: 8am to 5pm (M-F) Description Delivers... ...with the physician treatment plan. Utilizes clinical skills to assess, plan, implement... ..., concurrent, and retrospective reviews for inpatient acute care, rehabilitation,...Remote workImmediate start
- ...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
- ...The Association of California Nurse Leaders is seeking Clinical Utilization Review Nurses (RNs) for a remote position focusing on assessing medical necessity and quality of healthcare services. Applicants must possess a BA/BS in Nursing, an active Alabama RN license,...Remote work
- ...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
$85.99k - $105.34k
...A community-focused healthcare organization in Oregon is seeking a Utilization Review Nurse for a full-time remote position. The role involves evaluating clinical service requests, conducting prior authorization reviews, and collaborating with interdisciplinary teams....Remote workFull time- ...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
- 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
- ...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
- 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
- ...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

