Top 8235 Utilization Management Rn Jobs

Remote Home Health RN – Medical Claims Reviewer
Broadway Ventures —Remote
- $60,000 - $63,000 a year
- Full-time
- Remote
- Nursing
- RN License
- Customer service
- Disability insurance
- Dental insurance
Quick Apply
Utilization Management Registered Nurse
West Coast Consulting —Remote
- $30 - $34 an hour
- Contract
- Remote
- RN License
- Mid-level
- Nursing
- 401(k)
Quick Apply
7d
Denials & Appeals Administrator (RN)
Boston Medical Center —Remote
- $43.03 - $62.50 an hour
- Full-time
- Remote
- Nursing
- RN License
- 5 years
- Health insurance
- Dental insurance
Health Nurse - Utilization Management
Alterwood Health —Remote
- $75,000 - $95,000 a year
- Full-time
- Microsoft Word
- Background check
- Nursing
- Health savings account
- Disability insurance
Quick Apply
9d
Medical Management - Utilization Management RN 145-2026
CommunityCare —Remote
- Full-time
- Remote
- Background check
- Nursing
- RN License
Quick Apply
7d
Medical Management - Utilization Management RN 145-2011
CommunityCare —Remote
- Full-time
- Remote
- Background check
- Nursing
- RN License
Quick Apply
7d
Clinical Reimbursement Specialist (MDS) - Groves Center-3K retention bonus
The Groves Center —Lake Wales, FL
- Full-time
- Background check
- CPR Certification
- Microsoft Outlook
- Health insurance
- Dental insurance
Registered Nurse - Case Manager
SSM Health —Lake Saint Louis, MO
- Part-time
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Health insurance
Clinical Coordinator - Utilization Review
Hampton-Newport News Community Services Board —Hampton, VA
- From $62,406 a year
- Full-time
- Acute care
- Mid-level
- 3 years
- Paid holidays
- Health insurance
Quick Apply
Clinical Coordinator (RN) - Part Time with Benefits
RestorixHealth —Redfield, SD
- Part-time
- Nursing
- RN License
- BLS Certification
- Health savings account
- AD&D insurance
Quick Apply
Care Manager - Registered Nurse
Crouse Hospital —Syracuse, NY
- $80,000 - $86,000 a year
- Weekends as needed
- Nursing
- RN License
- Hospital
- Health insurance
- Dental insurance
Quick Apply
Nurse Educator (RN)
Wake Robin Corporation —Shelburne, VT
- $36.70 - $44.77 an hour
- Weekends as needed
- Nursing
- RN License
- Mid-level
- 403(b) matching
- Disability insurance
Quick Apply
Staff Nurse - Case Manager
Skagit Regional Health —Mount Vernon, WA
- $40.54 - $73.92 an hour
- Full-time
- Nursing
- RN License
- Hospital
- Disability insurance
- Health insurance
Quick Apply
RN Case Manager
Cape Cod Post Acute —Brewster, MA
- $55 - $60 an hour
- Full-time
- Nursing
- Skilled nursing facility
- Bachelor of Science
- Dental insurance
- Tuition reimbursement
Quick Apply
1d
RN, Emergency Department Case Manager
Iredell Memorial Hospital Incorporated —Statesville, NC
- Weekends as needed
- Nursing
- RN License
- Word processing
Quick Apply
Director of Nursing
Friendly Senior Living —Rochester, NY
- $120,000 - $153,000 a year
- Microsoft Word
- Nursing
- Microsoft Excel
Quick Apply
8d
Registered Nurse Utilization Review, Case Management, Part Time,7P-7:30A
Baptist Health South Florida —South Miami, FL
- $73,860.80 - $98,234.86 a year
- Part-time
- Nursing
- RN License
- Mid-level
- Wellness program
- Health insurance
1d
RN Director of Nursing
Caris HealthCare —Chattanooga, TN
- $84,000 - $92,000 a year
- Nursing
- RN License
- Computer literacy
- Paid training
- Mileage reimbursement
Quick Apply
Program Director - RN - Full Time
RestorixHealth —Smithfield, VA
- $101,500 a year
- Full-time
- CPR Certification
- Nursing
- Microsoft Excel
- Health savings account
- AD&D insurance
Quick Apply
Travel Director of Nursing
Trio Healthcare —Roanoke, VA
- Travel nursing
- English
- Travel
- Recruiting
Quick Apply

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Remote Home Health RN – Medical Claims Reviewer

Broadway Ventures -
Remote

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Job Details

Full-time
$60,000 - $63,000 a year

Benefits

Disability insurance
Dental insurance
Paid time off
Vision insurance
401(k) matching
Life insurance

Qualifications

Nursing
Confidential information handling
Customer service
Word processing
Word embeddings
Task prioritization
Productivity software
Nursing

Full Job Description

At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we're more than a service provider—we're your trusted partner in innovation.

Job Type: Full-time (40 hours/week)
Schedule: Monday–Friday, 8:00 AM – 5:00 PM

Max Salary: W-2 ($60,000-$63,000)

Location: Remote (U.S. – Work from home)
Remote Work Requirements: High-speed internet (non-satellite) and a private, lockable home office
Equipment: You will be provided with all necessary equipment to perform your job effectively, including but not limited to a desktop computer, dual monitors, a headset, an ethernet cable, and additional accessories as needed.

About the Role

We are seeking a dedicated Registered Nurse (RN) to join our Medical Review team. This role involves conducting pre- and post-payment medical reviews to ensure compliance with established clinical criteria and guidelines. The ideal candidate will use their clinical expertise to assess medical necessity, appropriateness, and reimbursement eligibility while documenting decisions in accordance with regulatory and organizational requirements.

Key Responsibilities

Review medically complex claims, pre-authorization requests, appeals, and fraud/abuse referrals.
Assess payment determinations using clinical information and established guidelines.
Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement.
Provide clear, well-documented rationales for service approvals or denials.
Educate internal and external teams on medical review processes, coverage determinations, and coding requirements.
Support quality control activities to meet corporate and team objectives.
Provide guidance to LPN team members and support non-clinical staff through training and discussions.
Assist with special projects and additional responsibilities as assigned.

Minimum Qualifications

Licensure:

Active, unrestricted RN license in the U.S. and in the state of hire
OR
Active compact multistate RN license (as defined by the Nurse Licensure Compact).

Education:

Associate Degree in Nursing
OR
Graduate of an accredited School of Nursing.

Experience:

Two years of clinical experience plus at least two years in one of the following:
- Home Health (meets for both clinical and HH requirement for a total of 2 years)
- Utilization/Medical Review
- Quality Assurance

Skills & Competencies:

Strong clinical background in managed care, home health, rehabilitation, and/or medical-surgical settings.
Ability to interpret and apply medical review criteria and clinical guidelines.
Proficiency in Microsoft Office and word processing software.
Strong analytical, organizational, and decision-making skills.
Ability to work independently while managing priorities effectively.
Excellent customer service, communication, and critical thinking skills.
Ability to handle confidential information with discretion.

Preferred Qualifications

Three years of clinical nursing experience in Home Health, Utilization Review, Medical Review, or Quality Assurance (strongly preferred).
Proficiency in using multiple screens and software programs simultaneously.

If you are a detail-oriented RN with a passion for medical review, we encourage you to apply!

What to Expect Next:

After submitting your application, our recruiting team will review your qualifications. This may include a brief telephone interview or email communication to verify resume details and discuss compensation expectations. Interviews will be conducted with the most qualified candidates. Broadway Ventures conducts background checks and drug testing prior to the start of employment. Some positions may also require fingerprinting.

Broadway Ventures is an equal opportunity employer and a VEVRAA federal contractor. We do not discriminate against applicants or employees on the basis of race, color, religion, sex, national origin, age, disability, protected veteran status, or any other status protected by applicable law.

Reasonable accommodations are available for applicants with disabilities. Broadway Ventures utilizes the OFCCP-approved Voluntary Self-Identification of Disability Form (CC-305).

The pay range shown is a good-faith estimate of the compensation Broadway Ventures reasonably expects to pay for this position at the time of posting. It is not a guarantee of any particular wage, salary, or total compensation. Actual pay offered depends on job-related factors, which may include skills, experience, education, certifications and licensure, geographic work location, contract funding and budget. For positions covered by the Service Contract Act, pay is also governed by the applicable Department of Labor wage determination, which the government may revise.

Some positions are posted in support of a contract proposal that has not yet been awarded. Where that is the case, the position and its final compensation are contingent upon award of the contract to Broadway Ventures and on the terms of the awarded contract, including any government-approved labor rates and the applicable wage determination.

Broadway Ventures offers a comprehensive benefits package. A general description of benefits is below.

401(k) and company match
PTO that grows the longer you stay
Health, Vision, Dental
Company provided Life Insurance and Voluntary Life Insurance
Short Term Disability and Long Term Disability

Quick Apply

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Utilization Management Rn jobs

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