🧾 Utilization Management – Clinical Nurse 🩺

(Remote – U.S.)

βœ… Position Highlights
β€’ πŸ’Ό Employment Type: Full-Time
β€’ 🏑 Location: 100% Remote (U.S. only)
β€’ 🩻 Department: Utilization Management
β€’ 🧠 Role Type: Clinical RN – Telephonic & Concurrent Review


πŸ“‹ What You’ll Own
β€’ Conduct precertification reviews for inpatient/outpatient procedures
β€’ Apply clinical judgment and UM criteria to determine medical necessity
β€’ Collaborate with medical directors for complex case reviews
β€’ Perform telephonic and concurrent reviews for hospitalizations
β€’ Facilitate discharge planning and continuity of care
β€’ Draft compliant denial communications and support appeal processes
β€’ Educate providers on coverage determinations and managed care guidelines
β€’ Document all clinical and provider interactions thoroughly in the UM system
β€’ Identify members for case management programs and coordinate discharge services
β€’ Assist with cost-benefit analyses for exceptional coverage cases
β€’ Report potential quality issues, fraud, or abuse
β€’ Collaborate with UM analysts on appeals, complaints, and inter-rater reviews
β€’ Stay current with Medicaid manual updates and regulatory timelines


🎯 Must-Have Traits
β€’ Active RN license in an eNLC (Enhanced Nurse Licensure Compact) state
β€’ 3+ years of Nursing experience
β€’ 1+ year of Utilization Management experience
β€’ Skilled in reviewing clinical documentation, guidelines, and treatment plans
β€’ Proficient in Microsoft Office and EMR systems
β€’ Excellent organizational, time management, and communication skills
β€’ Independent, self-motivated, and regulatory-compliant


πŸ’» Remote Requirements
β€’ Must reside in the United States
β€’ Active eNLC RN license required
β€’ Reliable high-speed internet and dedicated workspace


πŸ’‘ Why It’s a Win for Remote Clinicians
This role combines clinical expertise with strategic decision-making in a fully remote setting. You’ll play a vital role in ensuring appropriate, quality care while maintaining work-life flexibility. Plus, you’ll help drive value-based healthcare outcomes without stepping away from your nursing roots.


✍️ Call to Action
If you’re a licensed RN with Utilization Management experience and a passion for delivering smart, patient-centered care from homeβ€”this is your opportunity. Apply now and help shape better healthcare delivery with every review you touch.

🧾 Medicaid Claims Processor 🩺

(Remote – U.S.)

βœ… Position Highlights
β€’ πŸ’Ό Employment Type: Full-Time
β€’ 🏑 Location: 100% Remote (U.S. only)
β€’ πŸ“Š Department: Claims Processing
β€’ πŸ”§ Software Experience Required: QNXT


πŸ“‹ What You’ll Own
β€’ Accurately process and adjudicate Medicaid insurance claims
β€’ Enter and verify data using QNXT systems
β€’ Ensure compliance with CMS guidelines and regulatory standards
β€’ Identify and resolve discrepancies or errors within claims
β€’ Maintain thorough documentation and reports to track claim outcomes
β€’ Communicate with internal teams and partners to resolve claim-related issues
β€’ Stay updated on industry policies, regulations, and Medicaid standards
β€’ Support claims team with process improvement initiatives and additional duties


🎯 Must-Have Traits
β€’ Minimum 1 year of Medicaid claims processing experience
β€’ Hands-on proficiency with QNXT claims system
β€’ High attention to detail with strong analytical and organizational skills
β€’ Ability to manage multiple claims under tight deadlines
β€’ Excellent written and verbal communication skills
β€’ Self-motivated and disciplined while working remotely
β€’ High school diploma or equivalent


πŸ’» Remote Requirements
β€’ Reliable internet and home office setup
β€’ Must reside in the United States
β€’ Ability to work independently with minimal supervision


πŸ’‘ Why It’s a Win for Remote Job Seekers
A great fit for detail-oriented professionals looking to apply their Medicaid claims expertise from home. This role offers the stability of full-time work, the flexibility of remote life, and the satisfaction of helping streamline vital healthcare reimbursements.


✍️ Call to Action
If you’re experienced with QNXT and Medicaid claims and thrive in a remote work environment, this is your opportunity. Apply now to help deliver accuracy, speed, and compliance in health claim processing.

🧾 Data Center Associate πŸŒ™

(Part-Time, Remote – Pacific Time Zone)

βœ… Position Highlights
β€’ πŸ’° Pay Rate:
 – Colorado (excl. Denver): $14.81/hr
 – Washington (excl. Seattle/SeaTac): $16.66/hr
β€’ πŸ•’ Part-Time | Casual Employment
β€’ πŸŒ™ Night Shift Only (starts between 6–7 PM PT, must work past midnight)
β€’ 🌎 Remote: Must reside in OR, WA, AZ, NV, ID, CO, or UT


πŸ“‹ What You’ll Own
β€’ Collect, sort, and input domestic theater and studio-related data
β€’ Monitor theater reporting timelines and escalate issues to day shift when appropriate
β€’ Research and verify pre-release data and missing/incomplete entries
β€’ Contact originators to resolve inconsistencies or incomplete data
β€’ Float between multiple job functions within the Data Center
β€’ Train new hires and assist peers as needed
β€’ Maintain high accuracy in data entry with minimal supervision
β€’ Suggest process improvements and demonstrate initiative in shifting responsibilities


🎯 Must-Have Traits
β€’ High school diploma or GED
β€’ 0–1 year of relevant experience
β€’ Strong data entry skills and attention to detail
β€’ Proficiency with Microsoft Office Suite
β€’ Familiarity with internet-based research
β€’ Strong written and verbal communication skills
β€’ Ability to meet deadlines and multitask in a fast-paced, remote environment
β€’ Willingness to work holidays, weekends, and consistent night shifts


πŸ’» Remote Requirements
β€’ Must reside in one of the following: Oregon, Washington, Arizona, Nevada, Idaho, Colorado, or Utah
β€’ Ability to work late-night hours consistently (starting 6–7 PM PT)
β€’ Stable internet connection and self-motivated workspace


πŸ’‘ Why It’s a Win for Remote Job Seekers
Perfect for night owls and detail-oriented individuals who enjoy focused, independent work. This flexible, part-time role offers steady late-night hours and a chance to build professional skills in data handling and researchβ€”all from home.


✍️ Call to Action
Ready to bring your precision and focus to the team? Apply now and join a remote-first role that keeps the data flowing long after dark.

🧾 Stop Loss Claims Trainer & Process Owner πŸ’Ό

(Remote / Hybrid – U.S.)

βœ… Position Highlights
β€’ πŸ’° Salary Range: $77,600 – $129,400 + bonus eligibility
β€’ πŸ•’ Full-Time | Remote or Hybrid Flexibility
β€’ πŸ“Œ Department: Stop Loss Claims
β€’ 🌟 Two unique openings focused on training, process optimization, and project leadership
β€’ πŸ’Ό Great opportunity for those with stop loss or insurance industry experience


πŸ“‹ What You’ll Own
β€’ Develop and maintain training materials, workflows, and documentation
β€’ Deliver onboarding and upskilling sessions for new and current employees
β€’ Collaborate cross-functionally to identify, implement, and document best practices
β€’ Lead or support special projects and initiatives that improve process, systems, and outcomes
β€’ Provide claims processing support during peak volume
β€’ Manage data reporting, analytics, and benchmarking
β€’ Coordinate with systems partners to enhance tools and support knowledge-sharing
β€’ Represent the team at conferences and internal strategic meetings
β€’ Document and share meeting notes and project updates with leadership


🎯 Must-Have Traits
β€’ 3–5 years’ experience in stop loss claims or related field
β€’ High School diploma required (Bachelor’s degree preferred)
β€’ Solid grasp of stop loss insurance principles and claims workflows
β€’ Proficiency in MS Office Suite (Outlook, Excel, PowerPoint, Word)
β€’ Familiarity with enterprise databases and process-based tech tools
β€’ Excellent analytical, communication, and facilitation skills
β€’ Comfortable leading change, mentoring peers, and managing projects
β€’ Resourceful and creative in solving complex problems and unifying teams
β€’ Able to travel occasionally (up to 10%)


πŸ’» Remote Requirements
β€’ Fully remote or hybrid roles available
β€’ Must be based in the U.S. and able to support EST time zone business hours
β€’ Ability to maintain confidentiality and performance in a digital workspace


πŸ’‘ Why It’s a Win for Remote Job Seekers
You’ll join a respected, mission-driven organization with opportunities to impact real operational change. With leadership support, rich learning resources, and a clear career path, Symetra is ideal for professionals who want to grow in the stop loss space while working with flexibility.


✍️ Call to Action
Ready to bring your experience and leadership to the table? Apply today and help shape the future of stop loss claims excellence at Symetra.