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- ...Responsible for providing telephonic and e-referral case review and authorization of services utilizing established mental health and substance abuse medical... ...duties as required. This position is full-time, fully remote (work from home) and requires some weekend, evening,...Remote workFull timeWork from homeShift workWeekend workAfternoon shift
MRINetwork
United States21 hours 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- ...Working remotely in a full-time capacity, the Behavioral Health Utilization Review Specialist will manage the authorization of treatment through insurance and managed care companies, performing pre-certification, concurrent, and appeal reviews while ensuring compliance...Remote workFull time
Virtual Vocations Inc
United States21 hours ago - ...necessary and efficient healthcare services, the full-time Utilization Review Specialist will evaluate patient records and treatment plans... ...maintain compliance with regulatory standards while working remotely. Key responsibilities: Review and analyze medical records and...Remote workFull time
Virtual Vocations Inc
United States1 day ago - ...Utilization Review Specialist/Behavioral Health Substance Abuse (Remote) The Utilization Review Specialist is responsible for all aspects of the authorization of treatment via insurance and managed care companies. The role involves providing appropriate client information...Remote jobFlexible hours
- ...efficient and streamlined manner. We are seeking to add an ABA Utilization Review (UR) Specialist to our growing team. The ABA UR Specialist... ...working in a cohesive and rewarding environment. This is a fully remote or office/home hybrid position. Responsibilities Review...Remote workWork at officeFlexible hours
Spectrum Billing Solutions
Skokie, IL1 day ago - ...while making a meaningful difference every day. Job Summary The Utilization Review department manages all aspects of a patient’s stay related to... ...to work a hybrid schedule of 2 days in office and 3 days remote after successfully completing their first 90 days in office and...Remote workFull timeWork at officeMonday to Friday
KVC Health Systems
Wichita, KS2 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 hoursICBD Holdings
Florida, NY1 day ago- ...Utilization Review Analyst Utilization Review Analyst conducts prospective, concurrent, and retrospective reviews of service authorizations... ...may occur outside of standard office hours. Hybrid (onsite/remote) work schedule available. The ideal candidate must be able to...Remote workWork at office
$78k - $88k
...Summary We are seeking a skilled Utilization Review Nurse to conduct prior authorization, prospective, concurrent, and retrospective reviews for medical necessity and appropriateness of services, following clinical criteria, coverage policies, and contract guidelines....Remote workFull timeContract workWork at officeWork from homeFlexible hoursGainwell Technologies
Juneau, AK2 days ago- ...Registered Nurse - Utilization Review About Company Bestica We at Bestica believe our success is a direct result of hard work and outstanding employee dedication. Our environment is dynamic, friendly, and collaborative. We foster a positive culture, where innovation...Remote work
Bestica Healthcare
United States1 day 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). Minimum of 3 years acute medical Care...Remote work
3B Healthcare, Inc.
United States4 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, NY21 hours ago - ...Job Title Utilization Management Nurse Job Description The Corporate UM and Denials... ...team is responsible for: medical necessity reviews, admission status determinations,... ...Ambulatory/Admin - Office for 3 months, then remote/hybrid. Promotes and facilitates...Remote workWork at office
$1,966 per week
...and nights! Paid Holidays Work-life balance. Remote/hybrid setting (once trained) ROLE DESCRIPTION: This individual will utilize clinical knowledge and communication skills... ...individual will defer decision to a second level reviewer. This individual interfaces with case...Remote workFull timeTemporary workPart timeWork at officeWork from homeMonday to FridayFlexible hoursHines
Rockford, IL1 day 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 $45k - $70k
...A healthcare services company is seeking a Utilization Management Nurse Reviewer to ensure medical services are used appropriately. The role involves reviewing medical records and coordinating care while adhering to guidelines. Candidates should possess an unrestricted...Remote workDane Street
New York, NY21 hours ago- ...RN Utilization Review Review patient medical records to assess the appropriateness and medical necessity of hospital admissions, continued... ...management experience (hospital-based) ~ Skilled experience with remote work Length of Assignment: 13 weeks Shift / Hours...Remote workShift workWeekend work
AMN Healthcare
United States21 hours ago - A leading staffing agency is looking for a Utilization Review Registered Nurse to work remotely with a major health insurance client. This role involves evaluating patient care cases and ensuring requested services align with medical necessity while adhering to confidentiality...Remote work
Insight Global
Raleigh, NC21 hours ago - ...A leading healthcare company in Washington, D.C. is seeking a Medical Director to oversee inpatient medical necessity reviews and utilization management. This role requires strong analytical and communication skills, as well as 5+ years of clinical experience post-residency...Remote work
Humana
Washington DC1 day ago $71.1k - $97.8k
...Hong Kong Study Skills Research Institute is seeking a Pre-Authorization Registered Nurse to join their team. This role involves reviewing prior authorization requests to ensure appropriate care while working from home. Ideal candidates will be licensed RNs with a minimum...Remote workWork from homeHong Kong Study Skills Research Institute
Juneau, AK1 day ago$50 per hour
...GreenLife Healthcare Staffing is looking for an experienced Registered Nurse Clinical Reviewer for a fully remote position with an hourly rate of $50. This role involves conducting utilization reviews and ensuring healthcare documentation compliance for a respected non-...Remote workHourly payGreenLife Healthcare Staffing
New York, NY2 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- ...COMAGINE HEALTH is seeking a Clinical Utilization Review Nurse (RN) for a full-time remote position focused on assessing healthcare services' necessity and quality. Candidates must possess a BA/BS in Nursing and a current RN license specific to New Mexico. The role involves...Remote workFull time
Comagine Health
Albuquerque, NM21 hours 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 - ...Brighton Health Plan Solutions, LLC is seeking an Utilization Management Nurse to perform medical necessity reviews remotely. Licensed LPN with strong MS Office skills will review clinical criteria, coordinate with care partners, and document determinations in compliance...Remote work
Brighton Health Plan Solutions
Chapel Hill, NC2 days ago - ...work from home team. This is a great opportunity for a local remote position. Schedule PRN (As needed) ~ Shifts will fall... ...experience performing care for hospitalized patients. ~2 years of utilization review (UR) experience reviewing hospital admissions for medical...Remote workReliefLocal areaWork from homeMonday to FridayFlexible hoursShift work
BJC HealthCare
Saint Louis, MO2 days ago - A recognized healthcare provider is seeking a Board Certified Orthopaedic Spine Surgeon to conduct utilization reviews. This telework position allows for a flexible schedule within a standard Monday - Friday work week. Responsibilities include reviewing medical records,...Remote workFor contractorsMonday to FridayFlexible hours
Dane Street
Washington DC2 days ago - ...A national insurance group in Omaha seeks a full-time Utilization Review Nurse to oversee treatment requests and ensure compliance with guidelines... ...accurate documentation. The position offers options for remote work, health insurance, and other competitive benefits. #J-18...Remote workFull time
Berkshire Hathaway Homestate Companies
Omaha, NE4 days ago - (CHR) Community Health Resources, Inc. is seeking a Utilization Review Therapist to manage authorization activities pertaining to IOP and Residential programs. This full-time, remote role requires a Master’s degree in behavioral health and relevant experience in treatment...Remote workFull time
(CHR) Community Health Resources, Inc.
Windsor, CT2 days ago
