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Remote Rn Jobs in Usa

Last updated: 1 day ago
  • Promoted
RN, UTILIZATION MANAGEMENT - REMOTE

RN, UTILIZATION MANAGEMENT - REMOTE

UnitedHealth GroupCA, United States
$28.03–$54.95 hourly
Remote
Full-time
Show moreLast updated: 1 day ago
  • Promoted
Remote RN Case Manager

Remote RN Case Manager

GuidehealthSaint Louis, MO, US
$70,000.00–$75,000.00 yearly
Remote
Show moreLast updated: 8 days ago
  • Promoted
Remote RN CDI Specialist

Remote RN CDI Specialist

TTF Search and StaffingMiami, FL, US
$46.00–$48.00 hourly
Remote
Full-time
Show moreLast updated: 2 days ago
  • Promoted
Appeals Nurse (RN) - Remote

Appeals Nurse (RN) - Remote

WPS Health SolutionsJacksonville, FL, United States
$66,000.00–$68,000.00 yearly
Remote
Show moreLast updated: 3 days ago
  • Promoted
ENGAGEMENT CENTER TRIAGE RN

ENGAGEMENT CENTER TRIAGE RN

Froedtert Memorial Lutheran HospitalREMOTE, OR, United States
Remote
Show moreLast updated: 5 days ago
  • Promoted
CLINICAL APPEALS RN (REMOTE)

CLINICAL APPEALS RN (REMOTE)

System OnePittsburgh, PA, United States
$46.00–$100.00 hourly
Remote
Full-time
Show moreLast updated: 1 day ago
  • Promoted
RN, UTILIZATION MANAGEMENT - REMOTE

RN, UTILIZATION MANAGEMENT - REMOTE

UnitedHealth Group Inc.CA, United States
$28.03–$54.95 hourly
Remote
Full-time
Show moreLast updated: 1 day ago
  • Promoted
CARE MANAGER RN (REMOTE)

CARE MANAGER RN (REMOTE)

CVS HealthAustin, TX, United States
$60,522.80–$129,615.20 yearly
Remote
Full-time
Show moreLast updated: 1 day ago
  • Promoted
REMOTE RN TELEPHONE TRIAGE (NYS RN LICENSE REQUIRED)

REMOTE RN TELEPHONE TRIAGE (NYS RN LICENSE REQUIRED)

Virtual MedicalWilliamsville, NY, United States
$68,000.00–$71,500.00 yearly
Remote
Full-time
Show moreLast updated: 1 day ago
  • Promoted
Appeals Nurse (RN) - Remote

Appeals Nurse (RN) - Remote

WPSMadison, WI, United States
$66,000.00–$68,000.00 yearly
Remote
Full-time +1
Show moreLast updated: 7 days ago
  • Promoted
Remote RN - HEDIS Nurse

Remote RN - HEDIS Nurse

CSSCONTRACTNETWORKSAthens, Georgia, USA
$20.00–$45.00 hourly
Remote
Full-time
Show moreLast updated: 16 days ago
  • Promoted
Remote Patient Monitoring-RN

Remote Patient Monitoring-RN

Elevance HealthNashville, TN, United States
Remote
Full-time
Show moreLast updated: 25 days ago
  • Promoted
RN, UTILIZATION MANAGEMENT - REMOTE

RN, UTILIZATION MANAGEMENT - REMOTE

UnitedHealth Group, Inc.CA, United States
Remote
Full-time
Show moreLast updated: 1 day ago
  • Promoted
Remote Hybrid Clinic RN

Remote Hybrid Clinic RN

ChiOmaha, NE, United States
Remote
Full-time
Show moreLast updated: 3 days ago
  • Promoted
RN EVENING TRIAGE - REMOTE

RN EVENING TRIAGE - REMOTE

Allina Health SystemsMinneapolis, MN, United States
Remote
Permanent
Show moreLast updated: 1 day ago
Care Manager (RN)

Care Manager (RN)

Centene CorporationRaleigh, 1100 N. Raleigh Blvd, US
$54,000.00–$97,100.00 yearly
Remote
Full-time
Show moreLast updated: 30+ days ago
RN Educator

RN Educator

St. Croix HospiceOAKDALE, MN
Remote
Full-time
Show moreLast updated: 30+ days ago
  • Promoted
Remote Hybrid Clinic RN

Remote Hybrid Clinic RN

Catholic Health InitiativesOmaha, NE, United States
$23.98–$34.78 hourly
Remote
Full-time
Show moreLast updated: 17 days ago
  • Promoted
Remote Case Manager, RN

Remote Case Manager, RN

Piper CompaniesRemote, United States
$32.00–$37.00 hourly
Remote
Full-time
Show moreLast updated: 28 days ago
  • Promoted
RN Assessor - Hybrid Remote

RN Assessor - Hybrid Remote

MaximusBronx, NY, United States
$118,000.00 yearly
Remote
Full-time
Show moreLast updated: 11 days ago
RN, UTILIZATION MANAGEMENT - REMOTE

RN, UTILIZATION MANAGEMENT - REMOTE

UnitedHealth GroupCA, United States
1 day ago
Salary
$28.03–$54.95 hourly
Job type
  • Full-time
  • Remote
Job description

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start

  • Caring. Connecting. Growing together.

Optum's Pacific West region is redefining health care with a focus on health equity, affordability, quality, and convenience. From California to Oregon and Washington, we are focused on helping more than 2.5 million patients live healthier lives and helping the health system work better for everyone. At Optum Pacific West, we care. We care for our team members, our patients, and our communities. Join our culture of caring and make a positive and lasting impact on health care for millions.

As an RN, Unitarization Managment, you will be responsible for ensuring the integrity of the adverse determination processes and accuracy of clinical decision-making as it relates to the application of criteria and defined levels of hierarchy and composition of compliant denial notices.

If you are licensed in California, you will have the flexibility to work remotely

  • as you take on some tough challenges.
  • Primary Responsibilities :
  • Consistently exhibit behavior and communication skills demonstrating Optum's commitment to superior customer service, including quality, care, and concern with every internal and external customer
  • Perform all functions of a UM nurse reviewer
  • Compose denial letter in a manner consistent with federal regulations, state regulations, health plan requirements and NCQA standards
  • Construct denial notices to ensure the intended recipients understand the rationale for the denial of service and are specific to the member's condition and request
  • Ensure the denial reason is in the appropriate grade level and is easily understandable
  • Ensure the UM nurse reviewer has provided the appropriate reference for benefits, guidelines, criteria, or protocols based on the type of denial
  • Select the correct hierarchy level and apply it correctly based on the available medical information
  • Provide relevant clinical information to the request and the criteria used for decision-making
  • Ensure that there is evidence that the UM nurse reviewer documented communications with the requesting provider to validate the presence or absence of clinical information related to the criteria applied
  • Evaluate out-of-network and tertiary denials for accessibility within the network
  • Perform a quality assurance audit on each denial before finalization to ensure all elements comply with established guidelines
  • Consult with the medical director on cases that do not meet the established guidelines for a compliant denial notice for determination
  • Escalate non-compliance cases to UM compliance and consistently report on denial activities
  • Collaborate with UM compliance for continued quality improvement efforts for adverse determinations
  • Identify gaps in training or process impacting the overall compliance of adverse determinations and communicate an effective performance improvement solution in writing
  • Meets or exceeds productivity targets
  • Uses, protects, and discloses Optum patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
  • Performs additional duties as assigned
  • You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

  • Required Qualifications :
  • Graduation from an accredited school of nursing
  • Active, unrestricted Registered Nurse license through the State of California
  • 3+ years of care management, utilization review or discharge planning experience
  • Preferred Qualifications :
  • Bachelor of Science in Nursing, BSN
  • HMO Experience
  • All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
  • California Residents Only :
  • The hourly range for this role is $28.03 to $54.95 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives. .
  • At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._

    Diversity creates a healthier atmosphere : OptumCare is an Equal Employment Opportunity / Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law._

    OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._