Atlanta, GA · Remote
$35 - $45.94/hr
We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;
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Atlanta, GA · Remote
$35 - $45.94/hr
We're hiring a Utilization Review Nurse to join our Utilization Review team. About the role: You ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;
Atlanta, GA · Remote
$83K - $109K/yr
This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas ... HEDIS measures and other regulatory requirements. * CCM or MCG certification. * Experience ...
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Atlanta, GA · Remote
$83K - $109K/yr
This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas ... HEDIS measures and other regulatory requirements. * CCM or MCG certification. * Experience ...
... HEDIS, Star measures, preventive care, chronic-condition documentation, HCCs and chart review ... Bachelor's degree in health informatics, healthcare administration, nursing, public health, health ...
... HEDIS, Star measures, preventive care, chronic-condition documentation, HCCs and chart review ... Bachelor's degree in health informatics, healthcare administration, nursing, public health, health ...
Atlanta, GA · On-site +1
$42/hr
In this remote role, you will be responsible for conducting Medicare Annual Wellness Visits (AWVs ... Virtually reviewing and updating patient medical histories, including medication lists ...
Atlanta, GA · On-site +1
$42/hr
In this remote role, you will be responsible for conducting Medicare Annual Wellness Visits (AWVs ... Virtually reviewing and updating patient medical histories, including medication lists ...
Atlanta, GA · Remote
$42/hr
In this remote role, you will be responsible for conducting Medicare Annual Wellness Visits (AWVs ... Virtually reviewing and updating patient medical histories, including medication lists ...
Atlanta, GA · Remote
$42/hr
In this remote role, you will be responsible for conducting Medicare Annual Wellness Visits (AWVs ... Virtually reviewing and updating patient medical histories, including medication lists ...
Atlanta, GA · On-site +1
$42/hr
In this remote role, you will be responsible for conducting Medicare Annual Wellness Visits (AWVs ... Virtually reviewing and updating patient medical histories, including medication lists ...
Atlanta, GA · On-site +1
$42/hr
In this remote role, you will be responsible for conducting Medicare Annual Wellness Visits (AWVs ... Virtually reviewing and updating patient medical histories, including medication lists ...
Atlanta, GA · Remote
$42/hr
In this remote role, you will be responsible for conducting Medicare Annual Wellness Visits (AWVs ... Virtually reviewing and updating patient medical histories, including medication lists ...
Atlanta, GA · Remote
$42/hr
In this remote role, you will be responsible for conducting Medicare Annual Wellness Visits (AWVs ... Virtually reviewing and updating patient medical histories, including medication lists ...
Atlanta, GA · Remote
$42/hr
In this remote role, you will be responsible for conducting Medicare Annual Wellness Visits (AWVs ... Virtually reviewing and updating patient medical histories, including medication lists ...
Atlanta, GA · Remote
$42/hr
In this remote role, you will be responsible for conducting Medicare Annual Wellness Visits (AWVs ... Virtually reviewing and updating patient medical histories, including medication lists ...
Atlanta, GA · Remote
In this remote role, you will be responsible for conducting Medicare Annual Wellness Visits (AWVs ... Virtually reviewing and updating patient medical histories, including medication lists ...
Quick apply
Atlanta, GA · Remote
In this remote role, you will be responsible for conducting Medicare Annual Wellness Visits (AWVs ... Virtually reviewing and updating patient medical histories, including medication lists ...
Atlanta, GA · Remote
In this remote role, you will be responsible for conducting Medicare Annual Wellness Visits (AWVs ... Virtually reviewing and updating patient medical histories, including medication lists ...
Quick apply
Atlanta, GA · Remote
In this remote role, you will be responsible for conducting Medicare Annual Wellness Visits (AWVs ... Virtually reviewing and updating patient medical histories, including medication lists ...
Atlanta, GA · On-site +1
$42/hr
In this remote role, you will be responsible for conducting Medicare Annual Wellness Visits (AWVs ... Virtually reviewing and updating patient medical histories, including medication lists ...
Atlanta, GA · On-site +1
$42/hr
In this remote role, you will be responsible for conducting Medicare Annual Wellness Visits (AWVs ... Virtually reviewing and updating patient medical histories, including medication lists ...
Atlanta, GA · Remote
In this remote role, you will be responsible for conducting Medicare Annual Wellness Visits (AWVs ... Virtually reviewing and updating patient medical histories, including medication lists ...
Quick apply
Atlanta, GA · Remote
In this remote role, you will be responsible for conducting Medicare Annual Wellness Visits (AWVs ... Virtually reviewing and updating patient medical histories, including medication lists ...
Atlanta, GA · Remote
$30/hr
Multi-State Nurse Practitioner (NP) - Contracted Location: Remote -- United States THE HIGHLIGHTS ... chart review, and care coordination -- for the visit to be billable. Payment is issued for ...
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Atlanta, GA · Remote
$30/hr
Multi-State Nurse Practitioner (NP) - Contracted Location: Remote -- United States THE HIGHLIGHTS ... chart review, and care coordination -- for the visit to be billable. Payment is issued for ...
... affordability, improve HEDIS and CMS Star performance, reduce unwarranted utilization, and ... The CMO also partners with providers on evolving priorities, measure updates, and peer review ...
... affordability, improve HEDIS and CMS Star performance, reduce unwarranted utilization, and ... The CMO also partners with providers on evolving priorities, measure updates, and peer review ...
... affordability, improve HEDIS and CMS Star performance, reduce unwarranted utilization, and ... The CMO also partners with providers on evolving priorities, measure updates, and peer review ...
... affordability, improve HEDIS and CMS Star performance, reduce unwarranted utilization, and ... The CMO also partners with providers on evolving priorities, measure updates, and peer review ...
Atlanta, GA · Remote
$33 - $35/hr
Remote Triage & Home Health RN experience highly preferred *Potential Start Date: 9/14/26 New ... Ensure compliance with state/local/payer requirements through review of documentation * Provide ...
Atlanta, GA · Remote
$33 - $35/hr
Remote Triage & Home Health RN experience highly preferred *Potential Start Date: 9/14/26 New ... Ensure compliance with state/local/payer requirements through review of documentation * Provide ...
... ) to serve our patient population in the navigation, prevention and management of their health ... Welcome patients into continuous care program(s) and review benefits and services included
... ) to serve our patient population in the navigation, prevention and management of their health ... Welcome patients into continuous care program(s) and review benefits and services included
... ) to serve our patient population in the navigation, prevention and management of their health ... Welcome patients into continuous care program(s) and review benefits and services included
Quick apply
... ) to serve our patient population in the navigation, prevention and management of their health ... Welcome patients into continuous care program(s) and review benefits and services included
Atlanta, GA · Remote
$21/hr
Remote Triage & Home Health LPN experience highly preferred *Potential Start Date: 8/10/26 New ... Ensure compliance with state/local/payer requirements through review of documentation * Provide ...
Atlanta, GA · Remote
$21/hr
Remote Triage & Home Health LPN experience highly preferred *Potential Start Date: 8/10/26 New ... Ensure compliance with state/local/payer requirements through review of documentation * Provide ...
Atlanta, GA · Remote
$21/hr
Remote Triage & Home Health LPN experience highly preferred *Potential Start Date: 9/14/26 New ... Ensure compliance with state/local/payer requirements through review of documentation * Provide ...
Atlanta, GA · Remote
$21/hr
Remote Triage & Home Health LPN experience highly preferred *Potential Start Date: 9/14/26 New ... Ensure compliance with state/local/payer requirements through review of documentation * Provide ...
$19.71 - $22.17
2% of jobs
$22.17 - $24.62
3% of jobs
$24.62 - $27.08
3% of jobs
$28.46 is the 25th percentile. Wages below this are outliers.
$27.08 - $29.53
29% of jobs
$29.53 - $31.98
6% of jobs
The median wage is $33.02 / hr.
$31.98 - $34.44
14% of jobs
$34.44 - $36.89
13% of jobs
$37.40 is the 75th percentile. Wages above this are outliers.
$36.89 - $39.34
19% of jobs
$39.34 - $41.80
5% of jobs
$41.80 - $44.25
3% of jobs
$44.25 - $46.70
1% of jobs
$19
$33
$46
| Aspect | Remote Hedis Review Nurse | Remote Utilization Review Nurse |
|---|---|---|
| Certifications | RN license, HEDIS knowledge | RN license, Utilization Review certification |
| Work Environment | Insurance companies, healthcare plans | Hospitals, insurance companies, healthcare organizations |
| Job Focus | HEDIS data collection and quality improvement | Assessing medical necessity and resource utilization |
Remote Hedis Review Nurses primarily focus on HEDIS data collection and quality metrics, while Remote Utilization Review Nurses evaluate medical necessity and resource use. Both roles require RN licensure, but the specific certifications and daily tasks differ, reflecting their distinct focus areas within healthcare quality and utilization management.
Healthcare Effectiveness Data and Information Set (HEDIS) is a system for assessing the quality of care and clinical performance. Your duties as a remote HEDIS review nurse are to assess medical records and clinical information to perform an analysis of a facility's quality of care. In this work from home job, you collect the data remotely and contact facilities and medical records departments on the phone when necessary. HEDIS has dozens of different parameters, so you assess the data to identify information that proves that the facility met those requirements. Your responsibilities include reporting your findings to the relevant administrators.
6.9
Based on 6 frontline employees who took The Breakroom Quiz
251st of 304 rated insurance
Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review team.
About the role:
You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. You will make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.
You will report into the Supervisor, Utilization Review.
Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Oklahoma; Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events.
Pay Transparency: The base pay for this role is: $35.00 - $45.94 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.
Responsibilities:
Requirements:
Bonus points:
This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.
At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.
Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.
Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.
Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known.
California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.
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Sourced by ZipRecruiter
Insurance services
1,001 - 5,000 Employees
New York, NY, US
2012
