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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
- 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
United States3 days ago - ...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, NC4 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 States3 days ago - ...Philadelphia, PA, in recruiting an Emergency Medicine physician for a non-clinical utilization review role. The position offers a daytime schedule Monday through Friday with the potential for remote work part of the time. Salary with incentives starts at $250K+ and includes...Remote workPart timeMonday to Friday
Enterprise Medical Recruiting
Abington, PA22 hours 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
$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, CA3 days ago- Major Hospital in the United States is seeking a skilled utilization review professional to review medical records for necessity and appropriateness of care. You will collaborate with providers, staff, insurers, and case managers to ensure patients receive the right level...Remote jobReliefWeekend workAfternoon shift
- ...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, IL2 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-...Remote workDaily paidFull time
The Florida House
United States1 day ago - 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
$70k - $100k
...part of the Surgery Partners network, is seeking an experienced Utilization Review Specialist to join its team in Addison, Texas. This position... ...is a hybrid opportunity offering the flexibility of three remote workdays per week while maintaining an onsite presence two days...Remote workPermanent employment2 days per weekTEKsystems
Addison, TX1 day ago- ...Utilization Review Specialist Remote, United States About the Role The purpose of this position is to ensure that the utilization process is thorough, organized and streamlined to provide the best possible length of stays for our patients. Given the complex nature...Remote work
Charlie Health
United States3 days ago - ...R1 RCM is seeking an experienced Utilization Review Author (RN) for our Physician Advisory Team. The role involves first-level admission and continued stay reviews using InterQual/MCG criteria and requires hospital-based UR or Case Management experience. The position...Remote workFlexible hours
R1 RCM
Nashville, TN3 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 work
Ascension
Milton, FL3 days ago $80 per hour
...healthcare professionals experienced in prior authorization, utilization management, clinical review, medical necessity criteria, payer authorization... ...healthcare operations.This role supports current and upcoming remote consulting opportunities focused on AI-assisted prior...Remote workHourly payPart timeFor contractorsWork at officeFlexible hours24-MAG LLC
New York, NY1 day ago- 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
- ...Utilization Review Specialist We're officially a Great Place To Work®! We've always believed that supporting our team is just as important as supporting our patients. Now, we're proud to share that we've earned Great Place To Work® Certification - based entirely on...Remote workPart time
Bradford at Warrior
United States1 day ago - ...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 States2 days ago - Palmetto GBA is seeking an experienced RN for remote utilization review to evaluate medical claims using established criteria and guidelines. The role emphasizes timely decisions, documentation, and collaboration with internal teams. You will work from a home office and...Remote jobWork from homeHome office
- ...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, TX22 hours ago - ...Responsible completion of assigned tasks related to preadmission reviews, continued stay reviews, medical necessity requests, and chart... ...appropriate services, in the least restrictive environment, utilizing proven clinical interventions will lead to the provision of safe...Remote workWork at office
We Level Up NJ
United States22 hours 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 jobFull timeWork 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 States1 day ago - ...hospitals to help improve the health of individuals and the quality of life in our community. New Horizons is seeking an Utilization Review Specialist , who will be responsible for following up on patient accounts when authorization for stay is required, initiate...Remote workLocal area
New Horizons
United States4 days ago $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- ...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
- ...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
- 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
