• Remote Utilization Review

    Actalent (Sunrise, FL)
    Actalent is Hiring a Remote DietitianPosition Purpose: The Registered Dietitian will provide clinical education and support for Ambetter members enrolled in Disease ... + Backed by a non-clinical support team and market-level partnerships. Work Environment Remote Work Pay and Benefits The pay range for this position is $32.00… more
    Actalent (10/01/25)
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  • Utilization Review Nurse

    Martin's Point Health Care (Portland, ME)
    …Point has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of a team responsible for ... reviews for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental policies as well… more
    Martin's Point Health Care (09/25/25)
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  • Utilization Management Nurse

    CVS Health (OH)
    …healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. **Position Summary** The Team Lead plays ... 5+ years of clinical practice experience in medical healthcare. + 3+ years Medical Review or Utilization Management experience. + 2+ years of experience with… more
    CVS Health (09/24/25)
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  • Behavioral Health Utilization Review

    Actalent (Sunrise, FL)
    Job Title: Behavioral Health Utilization Review NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing requests ... the interdisciplinary team, the UMN handles tasks related to utilization review across various specialties, medical treatments,...on Tuesdays and will be logged into Teams for remote shadowing. Job Type & Location This is a… more
    Actalent (10/04/25)
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  • Utilization Management Nurse

    CVS Health (Workman, MN)
    …for members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. In this role, you'll be at the ... times may vary based on business needs) Location: 100% Remote (US only) **About Us** American Health Holding, Inc....intensive outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or… more
    CVS Health (10/04/25)
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  • Utilization Management Nurse

    CVS Health (MI)
    …solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant - Oncology and Transplant to ... EST Hours; Shift times may vary based on business needs) **Location** : 100% Remote (US only) **Position Summary** American Health Holding, Inc. (AHH), a division of… more
    CVS Health (09/25/25)
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  • Utilization Management Nurse

    CVS Health (AZ)
    …difference in the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Oncology and Transplant, ... in ensuring members receive timely, medically necessary care through thoughtful clinical review and collaboration with providers. This fully remote position… more
    CVS Health (10/01/25)
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  • Utilization Review Nurse I

    Centene Corporation (New York, NY)
    …clinical license; and a NYS Driver's License or Identification card.** **Position Purpose:** The Utilization Review Nurse I provides first level clinical ... requiring authorization. Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care… more
    Centene Corporation (10/03/25)
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  • RN Utilization Review Remote

    HonorHealth (AZ)
    …communities across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
    HonorHealth (09/26/25)
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  • Clinical Resource Coordinator…

    Penn Medicine (Philadelphia, PA)
    …this rewarding and ** REMOTE RN** role! This role will focus primarily on utilization review which is why **we are seeking individuals who have between 3 ... quality data collection and risk management referral. Responsibilities: + Utilization management activities: monitor appropriate use of internal resources,… more
    Penn Medicine (10/02/25)
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  • Utilization Management Nurse

    CVS Health (VA)
    …Summary** This Utilization Management Nurse Consultant (UMNC) position is 100% remote . As a Utilization Nurse Consultant, you will utilize clinical ... MS Office suites experience including Outlook and Excel **Preferred Qualifications** + Utilization Review experience + Managed Care experience + Strong customer… more
    CVS Health (09/26/25)
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  • *RN Coordinator- Utilization Review

    Henry Ford Health System (Warren, MI)
    …Under minimal supervision, reviews and screens the appropriateness of services, the utilization of hospital resources and the quality of patient care rendered. ... and critical thinking to maximize reimbursement. EDUCATION/EXPERIENCE REQUIRED: + Registered Nurse required. + Minimum 3-5 years of clinical experience required. +… more
    Henry Ford Health System (09/25/25)
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  • Utilization Management Nurse

    CVS Health (Columbus, OH)
    …it all with heart, each and every day. **Position Summary** This is a fulltime remote Utilization Review opportunity. Working hours are four 10hr days ... UMNC participating in non-traditional, weekend shift rotation **Preferred Qualifications** + Utilization review experience + Experience with LTAC, skilled rehab,… more
    CVS Health (09/20/25)
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  • Manager, Healthcare Services; Utilization

    Molina Healthcare (GA)
    …performance of one or more of the following activities: care review , care management, utilization management (prior authorizations, inpatient/outpatient medical ... This position will offer remote work flexibility, however, the selected candidate must...some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and… more
    Molina Healthcare (09/19/25)
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  • Associate Manager, Clinical Health Services…

    CVS Health (UT)
    …in non-compact states as needed. + 5+ years of acute experience as a Registered Nurse + 3+ years of Utilization Management experience + 3+ year(s) of Appeals ... on business needs) Travel Required up to 5% for meetings/audits. Location: 100% Remote (US only) **About Us** American Health Holding, Inc. (AHH), a division of… more
    CVS Health (10/02/25)
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  • Director, Healthcare Services; Utilization

    Molina Healthcare (GA)
    This position will offer remote work flexibility, however, the selected candidate must reside in the state of Georgia. This position will require RN Licensure. JOB ... services professionals in some or all of the following functions: utilization management, care management, behavioral health and other programs. Leads team… more
    Molina Healthcare (09/19/25)
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  • Utilization Review Clinician…

    Centene Corporation (Raleigh, NC)
    …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... competitive benefits including a fresh perspective on workplace flexibility. POSITION IS REMOTE WITH POTENTIAL FOR WEEKEND AND HOLIDAY ROTATIONS**'** MUST HOLD NORTH… more
    Centene Corporation (09/25/25)
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  • RN Utilization Review Part- time Day

    Providence (Mission Hills, CA)
    …Schedule:** Part time **Job Shift:** Day **Career Track:** Nursing **Department:** 7000 UTILIZATION MGMT REMOTE **Address:** CA Mission Hills 15031 Rinaldi St ... **Description** Provide prospective, retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and review medical records… more
    Providence (10/01/25)
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  • Utilization Review Clinician - ABA

    Centene Corporation (Phoenix, AZ)
    …assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare ... Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers...teams to review care services related to Applied Behavior Analysis Services… more
    Centene Corporation (09/04/25)
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  • Director Utilization Management-Clinical…

    Texas Health Resources (Arlington, TX)
    Director Utilization Management-Clinical Review _Are you looking for a rewarding career with family-friendly hours and top-notch benefits? We're looking for ... Arlington, TX + Core work hours: Monday-Friday 8:00a-5:00p. This position is hybrid remote /onsite. Vast majority of time will be remote , but there will… more
    Texas Health Resources (09/25/25)
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