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  • Physician / Internal Medicine / California / Permanent / Remote Utilization Review Medical Director for Medicare Advantage - Sacramento, California Job

    $275k - $300k

     ...service line ~100% administrative, non-clinical role ~ Work from home, but candidate must be within reasonable driving distance of...  ...PTO ~ Requires 5+ years experience in Medicare Advantage Utilization Review/Utilization Management and an active unrestricted CA... 
    Work from home
    Permanent employment
    Full time
    Remote work
    Monday to Friday

    Integrity Healthcare...

    Sacramento, CA
    23 minutes agonew

  • Utilization Review Coordinator Supervisory Role - Behavioral Health.

     ...Job Description Utilization Review Coordinator Supervisory Role - Behavioral Health. Napa...  ...The Napa Valley Napa County is home to 140,000 residents who share a strong...  ...Clinicians , review data and trends, and work closely with program and fiscal staff to... 
    Suggested
    Full time
    Part time

    Napa County

    Napa, CA
    9 days ago

  • After Hours Behavioral Health Utilization Management Reviewer

     ...Role Overview: The After Hours Behavioral Health (BH) Utilization Management (UM) Reviewer is scheduled to work non-traditional hours to provide access to medical necessity determinations for urgent and contractually required coverage requests 24/7, 365 days a year.... 
    Suggested
    Remote work
    Flexible hours
    Saturday

    AmeriHealth Caritas

    Newtown Square, PA
    4 days ago

  • Physician Reviewer - Psychiatry (Utilization Review)

     ...Street, a nationally recognized Independent Review Organization (IRO), is expanding its...  ...Compensation Board Certification to conduct Utilization Reviews. This is a fully remote, non-...  ...supplemental income Fully remote – work from anywhere You control volume and... 
    Suggested
    Price work
    Extra income
    For contractors
    Remote work
    Flexible hours

    Dane Street

    United States
    3 days ago

  • Physician Reviewer - Psychiatry (Utilization Review) NY

     ...Dane Street: Dane Street is a leading Independent Review Organization (IRO) and national provider of Utilization Review services. As we continue to expand our...  ...supplemental income through non-traditional clinical work. Position Overview: We are currently seeking... 
    Suggested
    Extra income
    For contractors
    Remote work
    Flexible hours

    Dane Street

    United States
    1 day ago

  • Long Term Services & Support Reviewer Utilization Management

     ...(LTSS) Supervisor, the LTSS Reviewer is responsible for completing...  ...inpatient and outpatient services, working closely with Service...  ...Personal Assistance Services (PAS), home care (skilled) services,...  ...received, nature of the request, utilization determination (and events... 
    Suggested
    Remote work
    Flexible hours

    AmeriHealth Caritas

    Newtown Square, PA
    4 days ago

  • Utilization Review Nurse

     ...RN- Utilization Review Nurse Inpatient *Full Time - 100% Remote Opportunity* Must reside...  ...Tri-State Area - NY, NJ, or CT COME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY...  ...position from the comfort of your own home as you will be responsible for the assessment... 
    Work from home
    Full time
    Local area
    Remote work

    VillageCare

    New York, NY
    3 days ago

  • RN Utilization Management Reviewer

    $38.49 - $47.05 per hour

     ...healthcare? Bring your true colors to blue. The RoleThe Clinical Utilization Reviewer is responsible for facilitating care for members who may...  ...optimal health. This position is self-directed and works independently and collaboratively to facilitate care using clinical... 
    Suggested
    Hourly pay
    Work at office
    Remote work
    Flexible hours
    Shift work

    Blue Cross Blue Shield of Massachusetts

    Hingham, MA
    14 hours ago

  • Utilization Review Nurse- Remote

    $65k - $78k

     ...challenges. Join us and put your expertise to work in ways you never imagined possible. We...  ...Summary We are seeking a skilled Utilization Review Nurse to conduct prior authorization,...  ...What you should expect in this role Home-based position. High-speed internet... 
    Work from home
    Full time
    Contract work
    Work at office
    Remote work
    Flexible hours

    Gainwell Technologies

    Wilmington, NC
    4 days ago

  • Utilization Reviewer

    $40.61 - $60.96 per hour

     ...Under general supervision, provides utilization review and denials management for an assigned patient...  ...the general nature and level of work being performed by staff assigned to this...  ...CPUR) preferred. Additional experience in home health, ambulatory care, and/or occupational... 
    Suggested
    Relocation package

    University of Maryland Medical System

    Upper Marlboro, MD
    3 days ago

  • Quality Utilization Reviewer I

     ...Job Summary The UR Reviewer 1 is responsible for performing inpatient admission...  ...accredited School of Nursing or Social Work. ~ Experience ~2 years experience...  ...related field (i.e. 3rd party payer) ~ Utilization review experience preferred.... 
    Suggested

    Children's of Alabama

    Birmingham, AL
    3 days ago

  • Registered Nurse (RN) - Case Manager, Utilization Review

     ...Direct Hire is seeking a Registered Nurse (RN) Case Manager, Utilization Review for a nursing job in White Plains, New York. Job...  ...career. At Medical Solutions, you’ll find a great place to work and a career home. We’ve received Best Places to Work awards, landed top industry... 
    Work from home
    Immediate start
    Shift work

    Medical Solutions Direct Hire

    White Plains, NY
    1 day ago

  • Travel RN Case Manager - Utilization Review

    $113 per hour

     ...be determined. Posted job title: CA - RN Case Manager (Strong Utilization Review (InterQual) exp REQUIRED) M-F, no weekends - Rate $113 - (875...  ...our travelers are given the best customer service. Our team works hard to find the best jobs with the most aggressive rates! \... 
    Suggested
    Shift work

    Anders Group

    Greenbrae, CA
    4 days ago

  • Document Review and Data Entry Specialist

     ...About the job Document Review and Data Entry Specialist Job details Salary...  ...pride ourselves on providing our employees a work experience built on family values. Our...  ...the following: Use TRAX program areas utilized for Maintenance personnel and perform setup... 
    Suggested
    Hourly pay
    Full time
    Work experience placement
    Work at office

    RemoteOnline

    San Francisco, CA
    1 day ago

  • RN Utilization Reviewer Full Time 40 hours

     ...Shift 1st Shift (Days) Description Registered Nurse Utilization Reviewer At Bristol Health, we begin each day caring today for...  ...The appropriate Nurse Utilization Reviewer will have a strong working knowledge of nationally recognized criteria sets including... 
    Suggested
    Full time
    Shift work
    Day shift

    BRISTOL HOSPITAL GROUP

    Bristol, CT
    4 days ago

  • Travel Nurse RN - Case Manager, Utilization Review

     ...Job Description GQR Healthcare is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Tyler, Texas. Job Description & Requirements ~ Specialty: Utilization Review ~ Discipline: RN ~ Start Date: 11/03/2025 ~ Duration: 1... 
    Contract work
    Shift work

    GQR Healthcare

    Tyler, TX
    2 days ago

  • Travel Nurse RN - Case Manager, Utilization Review

     ...First Connect Health is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Greenbrae, California. Job...  ...care, respect, and responsiveness at every step. When you work with First Connect Health, you're not just another number — you... 
    Weekly pay
    Long term contract
    Temporary work
    Local area
    Shift work

    First Connect Health

    Greenbrae, CA
    4 days ago

  • Utilization Review Analyst - Registered Nurse (Full Time)

     ...Type: Regular Time Type: Full time Work Shift: Day (United States of America)...  ...Burlington, MA. Job Description: The Utilization Analyst works with physicians, the payers...  .... Using the concepts of utilization review, clinical documentation improvement and revenue... 
    Full time
    Shift work
    Weekend work

    Beth Israel Lahey Health

    Burlington, MA
    1 day ago

  • Travel RN Case Manager - Utilization Review - $3,164 per week

     ...AHA Must-Have: Strong assessment, discharge planning, and utilization review skills Description: The RN Case Manager coordinates patient care plans and services across the continuum of care. Works closely with providers, social workers, and external agencies... 
    Permanent employment
    Temporary work
    Zero hours contract
    Shift work

    Prime Staffing

    Greenbrae, CA
    3 days ago

  • Travel RN Case Manager - Utilization Review - $3,475 per week

     ...Employment Type: Travel Must have strong Utilization Review and InterQual experience REQUIRED!...  ...as one of the Best Staffing Firms to Work for.LanceSoft specializes in providing Registered...  ...Centers, Drug & Alcohol Facilities, Home Health & Community Health, Urgent Care... 
    Weekly pay
    Long term contract
    Permanent employment
    Temporary work
    Work at office
    Shift work

    LanceSoft

    Greenbrae, CA
    2 days ago

  • Occupational Therapist - Utilization Review

     ...Job Description Job Description Occupational Therapist – Utilization Review Location: Remote Licensure: Current, active, and unrestricted Occupational Therapy license issued by the Arkansas State Medical Board. Job SummaryAstyra is seeking a licensed Occupational... 
    Remote work

    Astyra Corporation

    Little Rock, AR
    6 days ago

  • Remote Data Entry Assistant - Work From Home

     ...About the job Remote Data Entry Assistant - Work From Home Role Review The Information Entry Operator is accountable for refining youngster...  ...as treatments Have strong interpersonal skill-sets utilizing refinement, perseverance as well as good behavior... 
    Work from home
    Remote work
    Sunday
    Afternoon shift

    Jobsultant Solutions

    United States
    1 day ago

  • Utilization Review Nurse-Remote-Contract

    $40 per hour

     ...Candidates must be based in TX. RN working in the insurance or managed care industry...  ...responsible for performing initial, concurrent review activities; discharge care coordination...  .... Provides information regarding utilization management requirements and operational... 
    Full time
    Contract work
    Work at office
    Remote work

    HireOps Staffing LLC

    Dallas, TX
    2 days ago

  • Psychologist Peer Review Utilization Management - Remote (Houston)

     ...millions of people live healthier lives. The work you do with our team will directly improve...  .... The role of the Psychologist Peer Review involves applying clinical criteria and...  ...Rehabilitation, Targeted Case Management, Home Based Habilitation, Supported Employment,... 
    Work from home
    Part time
    Work at office
    Local area
    Remote work

    Optum

    Houston, TX
    2 days ago

  • Travel RN Case Manager - Utilization Review - $2,916 per week

    $113 per hour

     ...be determined. Posted job title: CA - RN Case Manager (Strong Utilization Review (InterQual) exp REQUIRED) M-F, no weekends - Rate $113 - (875...  ...our travelers are given the best customer service. Our team works hard to find the best jobs with the most aggressive rates!... 
    Shift work

    Anders Group

    Greenbrae, CA
    2 days ago

  • Travel RN Case Manager - Utilization Review - $3,101 per week

     ...Description American Traveler has an immediate opening for a Travel RN Case Management/Utilization Review Case Management job in Greenbrae, California. RN travelers who work with us receive a highly competitive pay and benefits package. You'll enjoy the personalized... 
    Daily paid
    Temporary work
    Immediate start
    Shift work

    American Traveler

    Greenbrae, CA
    2 days ago

  • Psychologist Reviewer

    $86k - $154.7k

     ...Centene is Hiring – Remote Psychologist Reviewer (ABA) Centene is seeking a Remote Psychologist...  ...100% remote flexibility · Meaningful work improving care for youth with Autism ·...  ...education on best practice models and utilization management processes ~ Interact with... 
    Full time
    Part time
    Work at office
    Remote work
    Flexible hours

    Centene

    South Bend, IN
    26 days ago

  • ABA Utilization Review (UR) Specialist

     ...manner. We are seeking to add an ABA Utilization Review (UR) Specialist to our growing team. The...  ...motivated, detail-oriented and interested in working in a cohesive and rewarding environment. This is a remote or office/home hybrid position. Your Responsibilities... 
    Full time
    Work at office
    Remote work
    Flexible hours

    Spectrum Billing Solutions

    Skokie, IL
    a month ago

  • Utilization Manager Registered Nurse (RN) Reviewer - MA only!

    013650 CCA-Auth & Utilization Mgmt Position Summary: Reporting to...  ...Utilization Management (UM) Reviewer is responsible for day-to-day...  ...and Supports (LTSS),DME and Home Health (HH) Applies established...  ...planning as needed Works closely with CCA Clinicians,... 
    Work at office
    Local area
    Remote work
    Home office

    Commonwealth Care Alliance

    Boston, MA
    1 day ago

  • Physician Reviewer - Orthopedic Spine Surgery (Utilization Review) MS

     ...Street, a nationally recognized Independent Review Organization (IRO), is expanding its...  ...preferred) licensed in Mississippi to perform Utilization Reviews . This is a non-clinical,...  ...– predictable, supplemental income Work remotely from anywhere you choose... 
    Price work
    Extra income
    Contract work
    For contractors
    Remote work

    Dane Street, LLC

    Parchman, MS
    more than 2 months ago