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- Nationwide Children's Hospital is seeking a utilization review professional to evaluate behavioral health cases, ensuring medical necessity and... .... After a 90-day in-office training, the position offers remote work from home options. #J-18808-Ljbffr Nationwide-ChildrenRemote jobWork at officeWork from home
- ...Alliance Health is seeking a UM Clinical Specialist-LTSS for full-time remote work, NC-based. You will perform utilization reviews and authorizations for I/DD and TBI waivers, ensuring services meet clinical guidelines and are provided in the least restrictive setting....Remote workFull time
Alliance Health in
Morrisville, NC3 days ago - A leading medical review organization is seeking Board-Certified physicians in Gastroenterology for a flexible remote opportunity. This role requires conducting independent Utilization Reviews for just 1-2 hours per week, with no minimum commitment. Candidates must have...Remote workFlexible hours
Medical Review Institute
Dallas, TX2 days ago - ...To support effective utilization management, the part-time Senior Utilization Review Specialist will conduct concurrent and retrospective reviews of hospital services... ...collaborating with clinical teams in a fully remote capacity. Key Responsibilities Perform concurrent...Remote workPart time
Virtual Vocations Inc
United States2 days ago - ...accredited college or university in Nursing, Social Work, Behavioral Health or related field required preferred.2-3 years of utilization review experience in behavioral health, addiction treatment, or managed care.Strong understanding of ASAM criteria, LOCUS, DSM-5, diagnostic...Remote workDaily paidFull time
The Florida House
Deerfield Beach, FL3 days ago - ...ABA Utilization Review SpecialistSpectrum Billing Solutions offers industry-leading revenue cycle management services for healthcare providers... ...in a cohesive and rewarding environment. This is a fully remote or office/home hybrid position.Your Responsibilities:Review patient...Remote workWork at officeFlexible hours
Spectrum Billing Solutions
Skokie, IL1 day 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
United States4 days ago- ...as typing reports, handling files, and completing forms while answering incoming calls and supporting the Utilization Review/Case Management department. This remote role requires strong communication, multitasking, and proficiency with Microsoft Office, including Excel....Remote jobWork at office
- Spectrum Healthcare Resources seeks a Utilization Manager Registered Nurse (UMRN) to work entirely from home in a fully remote role. The nurse will review cases, educate patients on appropriate care, and manage health care costs for dependents of active duty and eligible...Remote jobWork from homeMonday to Friday
- Spectrum Billing Solutions is seeking an ABA Utilization Review (UR) Specialist to join their team. This fully remote or hybrid position involves reviewing clinical information and obtaining authorizations for ABA services. Candidates should have 3-5 years of relevant...Remote job
- FHE Health is seeking a Utilization Review Specialist to manage clinical authorization processes and coordinate with insurance payers for timely authorizations. The role supports access to treatment while ensuring documentation reflects medical necessity and compliance...Remote job
- A peer review organization is seeking a full-time remote Utilization Management Physician Reviewer. Ideal candidates must hold an MD, DO, or DPM degree with active board certification and unrestricted medical license in relevant states. The role involves performing detailed...Remote jobFull timeWork from home
- ...week. At Bradford Health Services, we don't just invest in our patients-we invest in our people. About the Role: The Utilization Review Specialist plays a critical role in ensuring that healthcare services provided to patients are medically necessary, efficient...Remote workPart time
ADDICTION AND MENTAL
United States1 day ago - ...HealthHelp is seeking a remote Utilization Review clinician (RN/LPN/LVN) to support medical necessity determinations across client programs. You will review cases, coordinate with providers, and ensure timely decisions in line with policy and regulatory requirements. Ideal...Remote workWork at office
HealthHelp
Houston, TX4 days ago - ...Remote DUR Pharmacist Safe & Cost-Effective Medication Use Work From Home Analyze medication use patterns, apply clinical guidelines... ...collaborate with providers all from home. This remote Drug Utilization Review Pharmacist role is ideal for pharmacists who enjoy clinical...Remote jobWork from home
- ...Remote Drug Utilization Review Pharmacist Safe & Cost-Effective Medication Use Work from home analyze medication use patterns, apply clinical guidelines, and collaborate with providers all from home. This remote Drug Utilization Review Pharmacist role is ideal for...Remote jobWork from home
$219k - $286.9k
Oscar Health is hiring a Physician Reviewer to join our Utilization Management team. You will determine the medical appropriateness of inpatient, outpatient... ...information and applying evidence-based guidelines. This remote role in the United States offers work from home with...Remote jobWork from home- ...Healthcare Utilization Review Specialist Join our team at Company and build a meaningful career in employee benefits solutions. As a Healthcare Utilization Review Specialist, you'll play a vital role in ensuring our clients and members receive the right care at the...Remote workFull timeTemporary workSummer workFlexible hours
Cobalt Benefits Group
United States13 hours ago - HonorHealth in Arizona seeks an Utilization Review RN Specialist to review and monitor utilization for cost-effective, high-quality care. This... ..., and a strong collaboration with physicians and care teams. Remote work is available after training. #J-18808-Ljbffr...Remote job
- Ampcus Inc. is seeking a Utilization Management Specialist (Remote) to review medical necessity and authorization for clinical services. The role emphasizes clinical nursing expertise, care management experience, and adherence to guidelines and policies. The position requires...Remote job
- ...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
- ...Mass Digital Health is seeking a Clinical Reviewer LPN for a work-from-home position. The role involves performing retrospective medical... ...in a relevant medical setting, and the ability to work in a remote environment. Comprehensive benefits are provided, including medical...Remote workContract workWork from home
Mass Digital Health
United States2 days ago - Ascension Sacred Heart Hospital is seeking a nurse to join our Utilization Management team in a remote role. You will perform prospective, concurrent, and retrospective reviews to ensure medical necessity and alignment with reimbursement policies. Join a multidisciplinary...Remote job
- ...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
United States4 days ago $219k - $286.9k
...Hi, we're Oscar. We're hiring a Physician Reviewer to join our Utilization Management team. Oscar is the first health insurance company built around... ..., Utilization Management. Work Location: This is a remote position, open to candidates who reside in the United States...Remote workFull timeLocal areaWork from homeHome officeWeekend workOscar Health
New York, NY19 hours ago$16.74 - $26.92 per hour
...Job Description Job Description The Utilization Review (UR) Intake Specialist provides staff support services including typing reports and... ...CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. #LI-Remote...Remote workHourly payMinimum wageFull timeWork at officeLocal areaFlexible hoursCorVel Healthcare Corporation
Irving, TX7 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
United States4 days ago - ...posting to physicians and working with members, providers, and facilities to ensure high-quality care in a remote environment, with rotating weekend utilization review coverage. The candidate should have 1-2 years in utilization management, 3-5 years clinical experience,...Remote job
$66.83k - $111.38k
...qualifications, and experience.Norfolk, VAWork ShiftFirst (Days)Overview:Sentara Health Plansis hiring a Utilization Review Nurse/ RN for Imaging/Commercial- Remote!Status: Full-time,permanent position (40 hours)Standard working hours: 8am to 5pm EST, M-F. Weekend and holiday...Remote workPermanent employmentFull timeTemporary workWork from homeShift workDay shiftSentara Health
Norfolk, VA2 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
United States3 days ago
