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Remote Uas Rn Jobs in Aberdeen, MD (NOW HIRING)

CareFirst

Clinical Navigator (Remote)

Baltimore, MD · Remote

The Clinical Navigator (RN) conducts concurrent review of inpatient level of care, managing the timely and smooth transition from inpatient care to home or other levels of care. Utilizing experience ...

CareFirst

Clinical Navigator (Remote)

Baltimore, MD · Remote

The Clinical Navigator (RN) conducts concurrent review of inpatient level of care, managing the timely and smooth transition from inpatient care to home or other levels of care. Utilizing experience ...

RELI GROUP INC

Medical Review Nurse III

Baltimore, MD · Remote

Registered Nurse, with a current unobstructed license to practice nursing in the United States ... Ability to work well in a remote team environment, to collaborate with others, and interface with ...

RELI Group Inc.

Medical Review Nurse III

Baltimore, MD · On-site +1

$80K - $95K/yr

Registered Nurse, with a current unobstructed license to practice nursing in the United States ... Ability to work well in a remote team environment, to collaborate with others, and interface with ...

Corvel

Telephonic Case Manager I

Nottingham, MD · Remote

$63K - $95K/yr

This is a remote role. This position requires a California RN Nursing License. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Provide medical case management to individuals through coordination with the ...

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Remote Uas Rn information

What is the difference between Remote Uas Rn vs Remote Uas Nurse?

AspectRemote Uas RnRemote Uas Nurse
CredentialsRegistered Nurse (RN) licenseRegistered Nurse (RN) license
Work EnvironmentRemote healthcare settings, telehealth platformsRemote healthcare settings, telehealth platforms
Industry UsageHealthcare, telemedicineHealthcare, telemedicine
Common Search IntentRemote Uas Rn vs Remote Uas NurseRemote Uas Nurse vs Remote Uas Rn

The roles of Remote Uas Rn and Remote Uas Nurse are similar, both requiring an RN license and working in remote healthcare environments. The main difference lies in terminology preferences; 'Remote Uas Rn' emphasizes the licensing aspect, while 'Remote Uas Nurse' is a more general term. Both positions focus on providing telehealth services, making them highly comparable in industry and work environment.

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Utilization Management Specialist

System One

Baltimore, MD • Remote

Contractor

Medical, Dental, Vision, Life, Retirement

Re-posted 25 days ago

Job description

Utilization Management Specialist (UM / Utilization Review Nurse) — Remote

Location: 100% Remote (U.S.) — Maryland compact/eligibility required Type: Contract (approx. 3 months; potential extension) Schedule: Mon–Fri, 8:00am–5:00pm ET (1-hour lunch) - Flex after ramp-up start time between 7:00am–9:00am ET Pay (W2): USD 51.00/H

Job overview

In this role, you’ll use your clinical background and utilization management experience to review requests for care and determine medical necessity, appropriateness, and benefit coverage. You’ll work fully remote and leverage MCG, medical policy, and regulatory guidelines while collaborating with Medical Directors and internal teams to support timely, accurate authorization decisions.

What you’ll do

  • Perform prospective, concurrent, and retrospective utilization reviews (medical + behavioral health).
  • Make medical necessity / appropriateness determinations and support prior authorizations.
  • Use clinical criteria and policy resources daily (including MCG / Milliman Care Guidelines).
  • Review clinical documentation, benefits, and mandates to ensure services align with coverage and guidelines.
  • Research diagnoses/treatments and high-cost services; summarize findings and escalate complex cases to Medical Directors as needed.
  • Collaborate with internal partners and providers to support benefit application and appropriate levels/settings of care.
  • Maintain accurate documentation and protect PHI while managing a busy caseload.

Required qualifications

  • Active RN or LPN license (RN preferred) — Maryland compact/eligibility required
  • 5+ years clinical nursing experience
  • 2+ years care management / utilization management experience
  • MCG experience (required)
  • Experience supporting Commercial/FEP/Medicare lines of business and applying medical policy/regulatory standards
  • Strong critical thinking, written communication, and ability to work independently in a remote setting
  • Comfortable with web-based tools + Microsoft Office (Word/Excel/PowerPoint)
  • Guiding Care and FACETS (required)

Nice to have

  • Critical Care or ER clinical background
  • Experience with LCD/NCD, Medicare guidelines, ASAM, or other authorization criteria sets

System One, and its subsidiaries including Joulé and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.

System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.

#M-1 #LI-AJ1 Ref: #851-Rockville-S1