Utilization Management Specialist (UM / Utilization Review Nurse) -- Remote Location: 100% Remote ... Active RN or LPN license (RN preferred) -- Maryland compact/eligibility required * 5+ years ...
Utilization Management Specialist (UM / Utilization Review Nurse) -- Remote Location: 100% Remote ... Active RN or LPN license (RN preferred) -- Maryland compact/eligibility required * 5+ years ...
Utilization Management Specialist (UM / Utilization Review Nurse) -- Remote Location: 100% Remote ... Active RN or LPN license (RN preferred) -- Maryland compact/eligibility required * 5+ years ...
Utilization Management Specialist (UM / Utilization Review Nurse) -- Remote Location: 100% Remote ... Active RN or LPN license (RN preferred) -- Maryland compact/eligibility required * 5+ years ...
Utilization Management Specialist (UM / Utilization Review Nurse) -- Remote Location: 100% Remote ... Active RN or LPN license (RN preferred) -- Maryland compact/eligibility required * 5+ years ...
Utilization Management Specialist (UM / Utilization Review Nurse) -- Remote Location: 100% Remote ... Active RN or LPN license (RN preferred) -- Maryland compact/eligibility required * 5+ years ...
Clinical Navigator (Remote)
Baltimore, MD ยท 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 ...
Clinical Navigator (Remote)
Baltimore, MD ยท 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 ...
Associate Medical Editor - Remote
Baltimore, MD ยท Remote
$85K - $90K/yr
The Associate Medical Editor is a licensed oncology registered nurse, preferably with a master ... This is a fully remote position and can be based anywhere within the U.S. ESSENTIAL FUNCTIONS:
Associate Medical Editor - Remote
Baltimore, MD ยท Remote
$85K - $90K/yr
The Associate Medical Editor is a licensed oncology registered nurse, preferably with a master ... This is a fully remote position and can be based anywhere within the U.S. ESSENTIAL FUNCTIONS:
Active RN license from the state licensing board. * Case Management certification (preferred)
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Active RN license from the state licensing board. * Case Management certification (preferred)
Active RN license from the state licensing board. * Case Management certification (preferred)
Quick apply
Apply Early
Active RN license from the state licensing board. * Case Management certification (preferred)
Apply Early
Medical Review Nurse III
Baltimore, MD ยท 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 ...
Medical Review Nurse III
Baltimore, MD ยท 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 ...
Medical Review Nurse III
Baltimore, MD ยท 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 ...
New
Medical Review Nurse III
Baltimore, MD ยท 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 ...
New
Bilingual (Spanish/English) Cardiometabolic Specialty Care Advanced Practice Provider
Nottingham, MD ยท On-site +1
$103K - $131K/yr
An active and clear RN and APRN or Physician Assistant license must be maintained while employed at ... no premium #LI-REMOTE The pay range listed for this position is the range the organization ...
Bilingual (Spanish/English) Cardiometabolic Specialty Care Advanced Practice Provider
Nottingham, MD ยท On-site +1
$103K - $131K/yr
An active and clear RN and APRN or Physician Assistant license must be maintained while employed at ... no premium #LI-REMOTE The pay range listed for this position is the range the organization ...
Bilingual (Spanish) Advanced Practice Provider (NP or PA): Cardiology
Nottingham, MD ยท On-site +1
$102K - $132K/yr
This position is a fully remote role and requires working hours in CST, MST, or PST. An active and clear RN and APRN or Physician Assistant license in AL, AZ, GA, IL, OH and/or TX is required at time ...
Bilingual (Spanish) Advanced Practice Provider (NP or PA): Cardiology
Nottingham, MD ยท On-site +1
$102K - $132K/yr
This position is a fully remote role and requires working hours in CST, MST, or PST. An active and clear RN and APRN or Physician Assistant license in AL, AZ, GA, IL, OH and/or TX is required at time ...
Cardiometabolic Specialty Care Advanced Practice Provider
Nottingham, MD ยท On-site +1
$96K - $131K/yr
An active and clear RN and APRN or Physician Assistant license must be maintained while employed at ... no premium #LI-REMOTE The pay range listed for this position is the range the organization ...
Cardiometabolic Specialty Care Advanced Practice Provider
Nottingham, MD ยท On-site +1
$96K - $131K/yr
An active and clear RN and APRN or Physician Assistant license must be maintained while employed at ... no premium #LI-REMOTE The pay range listed for this position is the range the organization ...
Remote - Care Coordinator - LPN - LVN - $21/hr - Day Shift
Baltimore, MD ยท On-site +1
$28/hr
Fully remote position - Work from the comfort of your own home in cozy clothes without a commute ... Consistent schedule - Full-Time Monday - Friday, no weekends, rotational on-call-once per year on ...
Remote - Care Coordinator - LPN - LVN - $21/hr - Day Shift
Baltimore, MD ยท On-site +1
$28/hr
Fully remote position - Work from the comfort of your own home in cozy clothes without a commute ... Consistent schedule - Full-Time Monday - Friday, no weekends, rotational on-call-once per year on ...
Fully remote position - Work from the comfort of your own home in cozy clothes without a commute ... Consistent schedule - Full-Time Monday - Friday, no weekends, rotational on-call-once per year on ...
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Apply Early
Fully remote position - Work from the comfort of your own home in cozy clothes without a commute ... Consistent schedule - Full-Time Monday - Friday, no weekends, rotational on-call-once per year on ...
Apply Early
Fully remote position - Work from the comfort of your own home in cozy clothes without a commute ... Consistent schedule - Full-Time Monday - Friday, no weekends, rotational on-call-once per year on ...
Fully remote position - Work from the comfort of your own home in cozy clothes without a commute ... Consistent schedule - Full-Time Monday - Friday, no weekends, rotational on-call-once per year on ...
Telephonic Case Manager I
Nottingham, MD ยท 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 ...
Quick apply
Telephonic Case Manager I
Nottingham, MD ยท 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 ...
Telephonic Case Manager I
Nottingham, MD ยท 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 ...
Telephonic Case Manager I
Nottingham, MD ยท 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 ...
Bilingual (English/Spanish) Transitions of Care RN Case Manager
Nottingham, MD ยท On-site +1
$85K - $100K/yr
Our ideal RN is caring, compassionate, solution-oriented and enthusiastic about providing an outstanding experience for Devoted Health's patients. They are committed to integrity, excellence, and ...
Bilingual (English/Spanish) Transitions of Care RN Case Manager
Nottingham, MD ยท On-site +1
$85K - $100K/yr
Our ideal RN is caring, compassionate, solution-oriented and enthusiastic about providing an outstanding experience for Devoted Health's patients. They are committed to integrity, excellence, and ...
Licensed Psychologist - Remote
Baltimore, MD ยท Remote
$55 - $70/hr
Work from the comfort of home (fully remote) * Flexible schedule - you set your own hours. * Free ... Also, we are unable to accept substance abuse counselors, school counselors, registered nurses ...
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Licensed Psychologist - Remote
Baltimore, MD ยท Remote
$55 - $70/hr
Work from the comfort of home (fully remote) * Flexible schedule - you set your own hours. * Free ... Also, we are unable to accept substance abuse counselors, school counselors, registered nurses ...
Apply Early
Healthcare Recruiter - East Coast
Baltimore, MD ยท Remote
$50K - $75K/yr
Location : REMOTE! Ideally works in East Coast timezone What You'll Do * Develop and execute ... Clinical background (RN, Allied Health) with recruiting experience is a bonus, but not required ...
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Healthcare Recruiter - East Coast
Baltimore, MD ยท Remote
$50K - $75K/yr
Location : REMOTE! Ideally works in East Coast timezone What You'll Do * Develop and execute ... Clinical background (RN, Allied Health) with recruiting experience is a bonus, but not required ...
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Remote Weekend Rn information
What are the key skills and qualifications needed to thrive as a Remote Weekend RN, and why are they important?
What is a Remote Weekend RN?
What are some common challenges faced by Remote Weekend RNs, and how can they be managed effectively?
What is the difference between Remote Weekend Rn vs Remote Night Rn?
| Aspect | Remote Weekend Rn | Remote Night Rn |
|---|---|---|
| Work Schedule | Weekend shifts, typically Saturday and Sunday | Night shifts, usually overnight hours |
| Certifications | Registered Nurse (RN) license, CPR, BLS | Registered Nurse (RN) license, CPR, BLS |
| Work Environment | Home-based telehealth or remote hospital settings | Home-based telehealth or remote hospital settings |
| Industry Usage | Healthcare, telehealth services | Healthcare, telehealth services |
The main difference between a Remote Weekend Rn and a Remote Night Rn lies in their work schedules. Weekend RNs work primarily on weekends, while Night RNs cover overnight shifts. Both roles require similar certifications and work in remote healthcare environments, serving telehealth or remote hospital settings. Your choice depends on your preferred working hours and schedule flexibility.
Contractor
Medical, Dental, Vision, Life, Retirement
Posted 10 days ago
Job description
Utilization Management Specialist (UM / Utilization Review Nurse) โ Remote
Location: 100% Remote (U.S.) โ Maryland compact/eligibility required Type: Contract (approx. 3 months; potential extension) Schedule: MonโFri, 8:00amโ5:00pm ET (1-hour lunch) - Flex after ramp-up start time between 7:00amโ9:00am ET Pay (W2): USD 51.00/H
Job overview
In this role, youโll use your clinical background and utilization management experience to review requests for care and determine medical necessity, appropriateness, and benefit coverage. Youโll 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 youโll 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) โ 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 Joulรฉ 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