Top 207 Utilization review nurse Jobs in Fully Remote]

Remote Care Management Nurse
Cambia Health Solutions —Utah
- $38.00 - $41.50 an hour
- Overtime
- Remote
- Background check
- Nursing
- Microsoft Outlook
- Health insurance
- Dental insurance
Quick Apply
TX, RN Certified Case Manager - Workers Compensation
The Reny Company —Dallas, TX
- $80,000 - $90,000 a year
- 8 hour shift
- Remote
- Nursing
- RN License
- Research
- Mileage reimbursement
- Disability insurance
Quick Apply
Medical Reviewer
Youth Extensions, Inc. —Remote
- $80 an hour
- Contract
- Remote
- Medicine
- Adults
- Mid-level
Quick Apply
5d
Utilization Review Nurse
OpTech LLC —Michigan
- $36 - $39 an hour
- Contract
- Remote
- Nursing
- RN License
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
11d
Utilization Management Nurse I, RN
Clever Care Health Plan —Huntington Beach, CA
- $34.98 - $42.85 an hour
- Full-time
- Remote
- Background check
- Spanish
- RN License
Concurrent Utilization Review Nurse, RN
NeueHealth —Los Angeles, CA
- $74,286.15 - $111,429.23 a year
- Remote
- Nursing
- RN License
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
Utilization Management Nurse (Sun–Thurs or Tues–Saturday)
Curana Health —Remote
- Weekends as needed
- Nursing
- LVN
- Mid-level
Utilization Review Nurse
Cobalt Benefits Group LLC —Dallas, TX
- $90,000 - $98,000 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Health savings account
- AD&D insurance
Quick Apply
10d
Utilization Review Nurse
Umpqua Health —Remote
- $85,000 - $105,340 a year
- Full-time
- Bilingual
- Nursing
- RN License
- Health insurance
- Dental insurance
Healthcare CDI Specialist
The CSI Companies —Jacksonville, FL
- Contract
- Remote
- Mid-level
- Discharge planning
- Medical terminology
Quick Apply
9d
Utilization Review Nurse
Bracane Co —Plano, TX
- Full-time
- Remote
- RN License
- Mid-level
- 3 years
Quick Apply
Medical Review Nurse - SNF/MDS Auditor
Machinify —Remote
- Remote
- Nursing
- RN License
- HIPAA
Utilization Management Nurse
Blue Eagle Consulting —Remote
- RN License
- Mid-level
- Nursing
Quick Apply
Clinical Medical Review Nurse (Remote)
CareFirst BlueCross BlueShield —Baltimore, MD
- $67,320 - $133,705 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- RN License
- 401(k)
Quick Apply
4d
Clinical Review Nurse
Ternium Revenue Cycle Management —Remote
- $65,000 - $85,000 a year
- Remote
- RN License
- 5 years
- Writing skills
- Dental insurance
- Paid time off
Quick Apply
Utilization Review Nurse (U)
University of Miami —Miami, FL
- Full-time
- Remote
- Nursing
- RN License
- 5 years
- Health insurance
- Dental insurance
11d
Remote Nurse Case Manager - Utilization Review SNF
LTC Ally —Remote
- From $30 an hour
- Full-time
- Remote
- LVN
- RN License
- Mid-level
- Health savings account
- Health insurance
Quick Apply
CA Utilization Review Nurse I
CorVel Corporation —Rancho Cucamonga, CA
- $30.64 - $45.80 an hour
- Full-time
- Remote
- Nursing
- LVN
- RN License
- Health savings account
- Disability insurance
Quick Apply
Home Health - Medical Reviewer (Remote)
Frontpoint Health, LLC —Remote
- Remote
- Nursing
- Driver's License
- Home Health
Quick Apply
INDEPENDENT REVIEW NURSE
iMPROve Health (MPRO) —Remote
- $34 - $42 an hour
- Part-time
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Disability insurance
- Health insurance
Quick Apply
5d

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utilization review nurse jobs near fully remote]

Remote Care Management Nurse

Cambia Health Solutions -
Utah

Quick Apply

Job Details

Full-time
$38.00 - $41.50 an hour

Benefits

Health insurance
Dental insurance
401(k)
Flexible spending account
Tuition reimbursement
Paid time off
Employee assistance program
Vision insurance
401(k) matching
Flexible schedule
Life insurance
Referral program

Qualifications

Microsoft Outlook
RN License
Customer service
Writing skills
Health insurance policy knowledge
Case management
Utilization management
Decision making
Industry trends
Clinical documentation
Time management

Full Job Description

Care Management Nurse
Remote within WA, OR, ID, UT. Candidates outside of these states will not be considered.

Primary Job Purpose

The Care Management Nurse provides clinical care management (such as case management, disease management, and/or care coordination) to best meet the member’s specific healthcare needs and to promote quality and cost-effective outcomes. Oversees a collaborative process with the member and those involved in the member’s care to assess, plan, implement, coordinate, monitor and evaluate care as needed.

General Functions and Outcomes

Responsible for essential activities of case management including assessment, planning, implementation, coordination, monitoring and evaluation.
Assessment: collection of in-depth information about a member’s situation and functioning to identify individual needs.
Planning: identification of specific objectives, goals, and actions designed to meet the member’s needs as identified in the assessment.
Implementation: execution of the specific case management activities that will lead to accomplishing the goals set forth in the plan.
Coordination: organization, securing, integrating and modifying resources.
Monitoring: gathering sufficient information to determine the plan’s effectiveness and the evaluation phase should determine the effectiveness of reaching the desired outcomes.
Applies clinical expertise and judgment to ensure compliance with medical policy, medical necessity guidelines, and accepted standards of care.
Utilizes evidence-based criteria that incorporates current and validated clinical research findings. Practices within the scope of their license.
Consults with physician advisors to ensure clinically appropriate determinations.
Serves as a resource to internal and external customers.
Collaborates with other departments to resolve claims, quality of care, member or provider issues.
Identifies problems or needed changes, recommends resolution, and participates in quality improvement efforts.
Responds in writing or by phone to members, providers and regulatory organizations in a professional manner while protecting confidentiality of sensitive documents and issues.
Provides consistent and accurate documentation.
Plans, organizes and prioritizes assignments to comply with performance standards, corporate goals, and established timelines.

Minimum Requirements

Knowledge of health insurance industry trends, technology and contractual arrangements.
General computer skills (including use of Microsoft Office, Outlook, internet search). Familiarity with health care documentation systems.
Strong oral, written and interpersonal communication and customer service skills.
Ability to interpret policies and procedures, make decisions, and communicate complex topics effectively.
Strong organization and time management skills with the ability to manage workload independently.
Ability to think critically and make decision within individual role and responsibility.

Normally to be proficient in the competencies listed above

Care Management Nurse would have a/an Associate or Bachelor’s Degree in Nursing or related field and 3 years of case management, utilization management, disease management, or behavioral health case management experience or equivalent combination of education and experience.

Required Licenses, Certifications, Registration, Etc.

Must have licensure or certification, in a state or territory of the United States, in a health or human services discipline that allows the professional to conduct an assessment independently as permitted within the scope of practice for the discipline (e.g. medical vs. behavioral health) and at least 3 years (or full time equivalent) of direct clinical care

Must have at least one of the following: Certification as a case manager from the URAC-approved list of certifications; or Bachelor’s degree (or higher) in a health or human services-related field (psychiatric RN or Master’s degree in Behavioral Health preferred for behavioral health care management); or Registered nurse (RN) license (must have a current unrestricted RN license for medical care management)

The expected hiring range for a Care Management Nurse is $38.00 - $41.50 an hour depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 10% .  The current full salary range for this role is $33.80 - $55.00 an hour.

At Cambia, we take a variety of factors into account when creating a job offer, including your skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. While we offer competitive salaries, in general, we do not hire candidates at or near the top of the pay range.

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email [email protected]
. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy
. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers
site.

Job Type: Full-time

Pay: $38.00 - $41.50 per hour

Expected hours: 40 per week

Benefits:

401(k)
401(k) matching
Dental insurance
Employee assistance program
Flexible schedule
Flexible spending account
Health insurance
Life insurance
Paid time off
Referral program
Tuition reimbursement
Vision insurance

Supplemental Pay:

Bonus opportunities
Overtime pay

Application Question(s):

Do you have a valid RN license in ID, OR, WA or UT?
Do you have at least 3 years clinical experience working directly with patients?

Location:

Utah (Required)

Work Location: Remote

Quick Apply

Refine Your Search

utilization review nurse jobs in fully remote]

Remote Care Management Nurse

TX, RN Certified Case Manager - Workers Compensation

Medical Reviewer

Utilization Review Nurse

Utilization Management Nurse I, RN

Concurrent Utilization Review Nurse, RN

Utilization Management Nurse (Sun–Thurs or Tues–Saturday)

Utilization Review Nurse

Utilization Review Nurse

Healthcare CDI Specialist

Utilization Review Nurse

Medical Review Nurse - SNF/MDS Auditor

Utilization Management Nurse

Clinical Medical Review Nurse (Remote)

Clinical Review Nurse

Utilization Review Nurse (U)

Remote Nurse Case Manager - Utilization Review SNF

CA Utilization Review Nurse I

Home Health - Medical Reviewer (Remote)

INDEPENDENT REVIEW NURSE

I want to receive the latest job alert for utilization review nurse in fully remote]

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