Spectrum Healthcare Resources has a need for a Utilization Manager Registered Nurse (UMRN) . These ... remote positions, working entirely from the Nurse's home. The Nurse will be reviewing cases ...
Spectrum Healthcare Resources has a need for a Utilization Manager Registered Nurse (UMRN) . These ... remote positions, working entirely from the Nurse's home. The Nurse will be reviewing cases ...
Spectrum Healthcare Resources has a need for a Utilization Manager Registered Nurse (UMRN) . These ... remote positions, working entirely from the Nurse's home. The Nurse will be reviewing cases ...
Spectrum Healthcare Resources has a need for a Utilization Manager Registered Nurse (UMRN) . These ... remote positions, working entirely from the Nurse's home. The Nurse will be reviewing cases ...
Exercise Integration and Readiness Coordinator
Honolulu, HI · On-site +1
$86K - $198K/yr
Remote Work: No Job Number: R0247104 Location: Honolulu,HI,US Share job via: Share Exercise ... Support asset utilization planning, reconstitution activities, lessons learned collection, and ...
Exercise Integration and Readiness Coordinator
Honolulu, HI · On-site +1
$86K - $198K/yr
Remote Work: No Job Number: R0247104 Location: Honolulu,HI,US Share job via: Share Exercise ... Support asset utilization planning, reconstitution activities, lessons learned collection, and ...
Continuity of Operations Planner
Honolulu, HI · On-site +1
$86K - $198K/yr
Remote Work: No Job Number: R0245834 Location: Honolulu,HI,US Share job via: Share Continuity of ... utilization, and training and exercise execution. Understand and be able to apply a variety of ...
Continuity of Operations Planner
Honolulu, HI · On-site +1
$86K - $198K/yr
Remote Work: No Job Number: R0245834 Location: Honolulu,HI,US Share job via: Share Continuity of ... utilization, and training and exercise execution. Understand and be able to apply a variety of ...
These is completely remote positions, working entirely from the Nurse's home, however, its an 8 week assignement, that could lead to a longer assignement. The Nurse will be performing assessments ...
These is completely remote positions, working entirely from the Nurse's home, however, its an 8 week assignement, that could lead to a longer assignement. The Nurse will be performing assessments ...
Remote Utilization Review information
What is a remote utilization review?
A Remote Utilization Review job involves assessing medical records and treatment plans to ensure they meet insurance guidelines and medical necessity criteria. Professionals in this role, often nurses or healthcare specialists, work remotely to review patient care for cost-effectiveness and compliance with policies. They collaborate with healthcare providers, insurance companies, and case managers to approve or deny services based on established guidelines. This position requires strong analytical skills, knowledge of medical policies, and attention to detail.
What does a remote utilization review do?
A typical day for a Remote Utilization Review professional involves reviewing patient medical records, evaluating the necessity of proposed treatments against established guidelines, and collaborating with healthcare providers to gather additional information when needed. You will spend much of your time analyzing documentation, submitting recommendations, and ensuring that care authorization decisions align with payer policies and clinical best practices. Communication with case managers, physicians, and insurance representatives is frequent and essential. The work is generally independent and deadline-driven but requires strong teamwork and responsiveness through virtual meetings, emails, and calls.
What are the key skills and qualifications needed to thrive in remote utilization review?
To thrive as a Remote Utilization Review professional, you need a solid foundation in clinical knowledge, critical thinking, and an active RN or LPN license, often supported by experience in case management or prior authorization. Familiarity with medical coding (ICD-10, CPT), electronic health records (EHRs), and utilization management software is typically required, along with URAC or related certifications. Excellent communication, attention to detail, and strong organizational skills help you efficiently manage cases and coordinate with providers and payers. These skills ensure accurate assessments of medical necessity, compliance with regulations, and effective remote collaboration with healthcare teams.
What are the most commonly searched types of Utilization Review jobs in Hawaii?
The most popular types of Utilization Review jobs in Hawaii are:
What are popular job titles related to Remote Utilization Review jobs in Hawaii?
For Remote Utilization Review jobs in Hawaii, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review jobs in Hawaii look for?
The top searched job categories for Remote Utilization Review jobs in Hawaii are:
What cities in Hawaii are hiring for Remote Utilization Review jobs?
Cities in Hawaii with the most Remote Utilization Review job openings:
Full-time
Posted 22 days ago
Job description
Job Description
Spectrum Healthcare Resources has a need for a Utilization Manager Registered Nurse (UMRN). These will be completely remote positions, working entirely from the Nurse's home. The Nurse will be reviewing cases, educating patients on appropriate care and managing health care costs for the dependents of our Nation's Active Duty and eligible retirees.
The Nurse will be working remotely Monday through Friday, 8 hours per day.
Requirements
- Bachelors Nursing Degree
- At least one active state nurse license, preferably compact state licensure
- At least 2 years' experience working as a UMRN, preferably in a remote or hybrid environment.
- Possess current certification in either
- Completion of an accredited Certified Professional Utilization Review (CPUR) program
- Certified Case Manager (CCM) issued by the Commission for Case Manager Certification.
--OR--
- Possess two (2) years of full-time broad based registered nurse experience in a utilization management review or a case management setting within the preceding five (5) years. Notwithstanding the aforementioned experience requirements, the HCWs must have pertinent clinical experience within the past two (2) years sufficient to demonstrate current clinical competency for the setting and procedures required by this contract.
- Highly organized, self-directed worker able to function in a high-volume environment without distractions.
- Strong verbal and written communication skills.
- Proficient level of experience with Microsoft Office applications and strong technical aptitude.
- Must have access to secure, high speed internet.
Company Overview:
Spectrum Healthcare Resources (SHR) was established in 1988 to deliver systems and processes designed to meet the unique needs of Military and VA Health Systems. SHR is a leading organization that provides physician and clinical staffing and management services to United States Military Treatment Facilities, VA clinics and other Federal Agencies through various contracting vehicles. A Joint Commission Health Care Staffing Services firm, SHR is the military staffing division of TeamHealth, a Nationwide organization that serves 850 civilian and military hospitals with a team of 9,600 affiliated health care professionals. EOE/Disabled/Veterans
Location : LocationUS-HI-HonoluluRecruiter : Full Name: First LastJoseph DayDirect phone number314-744-4138Recruiter : Emailjoseph_day@spectrumhealth.comEmployment Type: OTHER
About Spectrum Healthcare Resources
Sourced by ZipRecruiter
Spectrum is a leading organization that provides program management and physician and clinical staffing services to United States Military Treatment Facilities, VA Clinics and Federal Agencies. We are dedicated to the markets we serve, leading our organization’s experience for almost three decades.
Industry
Health care and social assistance
Company size
1,001 - 5,000 Employees
Headquarters location
Saint Louis, MO, US
Year founded
1988