• RN - Registered Nurse - Clinical…

    Geisinger (Danville, PA)
    …provided. The core of the program uses highly trained staff members to perform a concurrent inpatient review of the record. This allows the record to be coded ... follow a hybrid schedule, with some days designated for remote work. Please note that applicants must reside in...mortality, severity of illness; and initiate documentation of the review . + Pursues a subsequent review of… more
    Geisinger (10/08/25)
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  • Prior Authorization, RN - Hybrid Remote

    Fallon Health (Worcester, MA)
    …on Facebook, Twitter and LinkedIn. **Brief summary of purpose:** The PA Nurse uses a multidisciplinary approach to review service requests ... needs of FH members and their families. The PA Nurse is responsible for assuring the receipt of high...from medical care providers as needed for the clinical review process + Conducts pre-authorization and concurrent more
    Fallon Health (10/02/25)
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  • Nurse Manager

    BrightSpring Health Services (Mount Laurel, NJ)
    …Registered Professional Nurse + Excellent communicator with ability to handle concurrent tasks and responsibilities + Ability to travel within assigned area + ... meetings + Chairing committees as appropriate, safety, infection control, incident review , and human rights committees + Facilitating communication and serving as… more
    BrightSpring Health Services (09/27/25)
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  • Clinical Program Coordinator RN, Medicare…

    Providence (OR)
    …Planning, Coordination of Outpatient Care) + Utilization Management Experience (EX. Concurrent Review , Prior Authorization, Medical Audits, Appeals or ... nearing end of life + Care management services include: nurse education, care coordination and general assistance with managing...care to our members **Providence Health Plan welcomes 100% remote work to residents who reside in the following… more
    Providence (08/23/25)
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  • Clinical Documentation Integrity Specialist…

    TEKsystems (Milwaukee, WI)
    …RESIDE IN WI OR IA TO BE CONSIDERED**Key Responsibilities + Perform concurrent reviews of inpatient medical records to ensure documentation accurately reflects ... and maintain awareness of organizational updates and policies. Qualifications + Registered Nurse (RN) certification required + Minimum 5 years of full-time adult… more
    TEKsystems (09/26/25)
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  • Clinical Documentation Integrity Specialist- RN-…

    Beth Israel Lahey Health (Winchester, MA)
    …a job, you're making a difference in people's lives.** **This position is remote . Candidates must be local to New England States for consideration** The Clinical ... Documentation Improvement (CDI) Specialist Registered Nurse (RN) assists with the appropriate identification of diagnoses, conditions, and/or procedures that are… more
    Beth Israel Lahey Health (09/24/25)
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  • Utilization Management RN PRN

    AdventHealth (Altamonte Springs, FL)
    …shift, weekends as needed potentially up to 12-hour shifts **Job Location** : Remote **The role you will contribute:** The role of the Utilization Management (UM) ... Registered Nurse (RN) is to use clinical expertise by analyzing...to the Physician Advisor or designated leader for additional review as determined by department standards. Additionally, the UM… more
    AdventHealth (10/06/25)
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  • Utilization Review Clinician - Behavioral…

    Centene Corporation (Raleigh, NC)
    …medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine ... 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)
    **Description** Provide prospective, retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and review medical records ... + Associate's Degree Nursing. + Upon hire: California Registered Nurse License. + 2 years Experience working in a... License. + 2 years Experience working in a remote UR environment or working as an acute hospital… more
    Providence (10/07/25)
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  • Clinical Denials Prevention & Appeals Specialist…

    Nuvance Health (Danbury, CT)
    …payers. * If concurrent inpatient case does not meet medical necessity review criteria during the first level review , discuss with the attending MD ... DAY SHIFTS- VARIABLE HOURS / WEEKEND ROTATIONS REQUIRED* * *Hybrid/ Remote * * *Summary:* The purpose of the Denial Prevention...* * *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are… more
    Nuvance Health (09/26/25)
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