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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 jobLocal 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
Guidehealth
Peoria, IL2 days ago - ...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 workFull timeWork from home
ExamWorks
New York, NY16 hours agonew - ...Santa Barbara Cottage Hospital is hiring an LTC Utilization Management Reviewer for remote work in New Mexico. The role involves conducting Nursing Facility Level of Care determinations, performing utilization reviews, and ensuring services meet long-term care criteria...Remote work
Santa Barbara Cottage Hospital
New York, NY4 hours agonew - ...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 workTemporary workWork at officeWork from homeMonday to FridayFlexible hours
Hines & Associates Inc
Rockford, IL12 days 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$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 States20 hours ago- 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
- ...Providence Health Plan Group is seeking an RN Utilization Review for a remote, per diem position in Los Angeles. You will be responsible for conducting utilization reviews across Southern California ministries and require a strong clinical background. Ideal candidates...Remote workDaily paid
Providence Health Plan Group
Los Angeles, CA4 hours agonew $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 workPrime Healthcare
Ontario, CA1 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
$50k
...the lives of patients and their families What to Expect (Job Responsibilities) Complete pre-authorizations, concurrent reviews, and internal utilization review assessments Consult with the multidisciplinary treatment team to gather necessary information for concurrent...Remote workAdvanced Recovery Systems LLC
New York, NY16 hours agonew- 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
$35 - $45.94 per hour
...Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review team. About The Role You will perform frequent case... ...the Supervisor, Utilization Review. Work Location This is a remote position, open to candidates who reside in: Arizona; Florida;...Remote workHourly payFull timeWork from homeHome officeOscar Health
New York, NY16 hours agonew- ...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 - New-Freedom-Ops-LL in Phoenix, AZ is looking for a Utilization Review Specialist to oversee utilization review activities across behavioral health care. Responsibilities include conducting reviews, ensuring compliance with regulations, and liaising with clinical staff...Remote job
$45 - $50 per hour
...Utilization Management Nurse – Medicare Remote | California RN Required | Must sit in CA We’re partnering with a mission‑driven healthcare organization... ..., concurrent, and retrospective utilization reviews for Medicare members Apply evidence‑based clinical...Remote workContract workTemporary workWork from homeActalent
Rancho Cordova, CA5 days ago$75k
...for a Registered Nurse (RN) to perform concurrent inpatient utilization reviews. The role requires a BSN and current nursing license, with preference... ...with health, dental, and vision benefits. The position is remote with a standard Monday-Friday schedule and a supportive work...Remote jobMonday to Friday- ...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 - ...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
Guidehealth
Rockford, IL2 days 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
Peoria, IL2 days ago - ...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
Medical Review Institute
Salt Lake City, UT2 days ago - ...Job Title Utilization Review (UR) Specialist Job Description The Utilization Review (UR) Specialist is a Registered Nurse responsible... ...the time may be required. Work Type: This position is a remote position outside traditional office, often from home or another...Remote workWork at office
- ...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, NY16 hours agonew - ...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
3B Healthcare, Inc.
Torrance, CA1 day 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 hours- ...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
- ...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
Brighton Health Plan Solutions
Chapel Hill, NC2 days ago - ...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
BJC HealthCare
Kansas City, MO3 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
