Remote Dental UM Clinician — Prior Authorizations and Reviews
Avesis Incorporated
- Remote job
Avēsis seeks a skilled Utilization Management Clinical Dental Processor to review dental x-rays and patient histories, ensuring medical necessity for prior authorizations. You will work remotely, complete 13–18 cases per hour, and document decisions per client contracts. You will import documents into our system, review histories, and collaborate with the UM team to optimize processes. Overtime may be required during peak periods. #J-18808-Ljbffr Avesis Incorporated
- ...Provides support for clinical member services review assessment processes. Responsible for... .... Conducts reviews to determine prior authorization/financial responsibility for Molina and... .... Adheres to utilization management (UM) policies and procedures. Required Qualifications...Remote jobWork at office
$40 - $42 per hour
...agency currently looking for a Care Review Clinician I to work with our Managed Care Client... ...Holidays ***This is a fully remote role but candidates must have a valid... ...benefits and eligibility and Process prior authorization determinations within regulatory timelines...Remote workHourly payLocal areaMonday to Friday- ...Integra Partners is seeking a licensed Practical Nurse (LPN/LVN) experienced in managed care UM to perform pre-service and post-service utilization reviews and appeals for DMEPOS, working with our Medical Director in a NCQA-compliant UM program. You will review benefit...Remote work
$90k - $107k
...Health Plan Holding Company, Inc. is seeking a Remote UM Nurse to support network adequacy review and authorization activities for members in ACO, HMO, and EPO products... ...The role requires clinical knowledge to review prior authorization requests, assess medical necessity...Remote work$57 per hour
ProPivotal Staffing is seeking a Clinical Pharmacist Reviewer to work from home in Massachusetts. This role supports clinical pharmacy services and involves optimizing treatments with healthcare teams. Candidates should have 1-2 years of experience and an active Massachusetts...Remote jobHourly payWork from homeFlexible hours$23.76 - $51.49 per hour
...Provides support for clinical member services review assessment processes. Responsible for... .... Conducts reviews to determine prior authorization/financial responsibility for Molina and... ...model. Adheres to utilization management (UM) policies and procedures. Required Qualifications...Remote workHourly payWork experience placementWork at office$39k - $49.4k
...UM Administration Coordinator The UM... ...processes. This role reviews and processes... ...independently in a remote environment and maintain... ...related field. Prior customer service,... ...Management, Prior Authorization, Care Management,... ...provides medical, dental and vision...Remote workBi-weekly payTemporary workApprenticeshipWork at officeWork from homeHome office- ...seeking an experienced Utilization Management (UM) Registered Nurse to support outpatient utilization review and prior authorization activities for a leading healthcare... ...interdisciplinary teams.Ability to work independently in a remote environment.Comfortable using multiple...Remote workContract work
$30 - $34 per hour
...Overview Utilization Review Nurse - Remote at Astrana Health Location: 600 City Parkway... ...- $34.00 / hour Department: HS - UM This is a fully remote position.... ...One Team What You'll Do Complete prior authorization/retrospective review of elective inpatient...Remote workHourly payMonday to Friday$40k - $52.3k
...for the Bilingual Telephonic UM Coordinator role at... ...Experience with Utilization Review and/or Prior Authorization, preferably within a managed... .... Travel: While this is a remote position, occasional travel... ..., Humana provides medical, dental and vision benefits, 401(k)...Remote workBi-weekly payFull timeTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to FridayNight shiftWeekend work- ...Job Title External Physician Reviewer Job Type Occasional Category Medical Services Location Work from Home... ...AFMC is looking to contract with physicians to complete prior authorizations and retrospective reviews on a home laptop or desktop computer...Remote workFull timeContract workLocal areaWork from home
- ...Utilization Review NurseThis position has a remote option for those living close and will be able to come... ...admission, concurrent, and retrospective UM related reviews and functions.... ...Others, or Leader of Leaders.The prior authorization role completes an assessment of a...Remote workFull time
- ...UM Review Assistant Location: CA (remote) Duration: 6 months Provide primary non-clinical program support by encompassing provider training, customer service, call triaging, authorization preparation, data entry, and the development and tracking of functions for...Remote workContract workWork experience placementWork at officeFlexible hours
- ...consulting. We are seeking an experienced Case Reviewer to join our healthcare consulting practice. The role is fully remote within the US, however must be located in... ...review and medical management of prior authorizations for plans of service. This position requires...Remote workLocal areaWork from home
- ...healthcare staffing firm is seeking a Pharmacy Technician to support retail pharmacy operations remotely. This role involves processing prescriptions, performing prior authorization reviews, and coordinating care for patients. Candidates should have at least 2 years in retail...Remote work
$27.02 - $48.55 per hour
...Position Purpose: Performs concurrent reviews, including determining member's overall... ...member. Key Details: The position is remote/work from home; applicants must hold an... ...inpatient only, and will be cross trained for Prior Authorization. The work schedule is Monday -...Remote workHourly payFull timePart timeWork at officeWork from homeMonday to FridayFlexible hours- ...Detail-oriented and knowledgeable, the full-time remote Utilization Review Coordinator will manage client insurance authorization processes for Spravato and TMS services,... ...guidelines. Key responsibilities Obtain and manage prior authorizations for Spravato and TMS services...Remote workFull time
- A healthcare staffing company is seeking a Clinical Review Nurse for Prior Authorization Review. This remote role demands conducting reviews, collaborating with healthcare teams, and ensuring compliance. Candidates need an active RN license and 2-4 years experience in...Remote workContract work
$85.99k - $105.34k
...-focused healthcare organization in Oregon is seeking a Utilization Review Nurse for a full-time remote position. The role involves evaluating clinical service requests, conducting prior authorization reviews, and collaborating with interdisciplinary teams. Applicants...Remote workFull time- A healthcare management company is seeking a Remote Coverage Review Pharmacist located in Tennessee. This role requires a Doctor of Pharmacy... ...will be responsible for reviewing medication-related prior authorizations, appeals, and grievances, working independently or in a...Remote work
- ...Resources Management Location: 100% Remote Schedule: M-F 9:00am to 5:30pm with... ...benefits and eligibility Process prior authorization determinations within regulatory timelines... ...medical necessity/utilization review and other utilization management activities...Remote workContract work
- American Health Holding, Inc. (AHH) offers a fully remote Utilization Management Nurse Consultant role focused on medical review for members. You will apply clinical judgment to assess necessity and collaborate with providers to ensure timely care. This desk-based position...Remote job
- ...Position Title: Clinical Review Nurse - Prior Authorization Assignment Duration: 6 months; potential to extend/convert Work Schedule: OT as... ...Mon - Fri / Possible holiday shifts Work Arrangement: Remote-Central Time Zone preferred Responsibilities: Centralized...Remote workShift work
- ...Washington DC area, is seeking an experienced Case Reviewer to join our healthcare consulting practice. This fully remote role allows you to work from anywhere in the... ...perform utilization review and medical management of prior authorizations, ensuring #J-18808-Ljbffr JoblessRemote job
$150 per hour
Mercor is seeking a Prior Authorisation Manager to manage end-to-end workflows for medical... ...in San Francisco, the role entails reviewing clinical documentation and coordinating with... ...communication skills are essential. This is a remote contract position offering $150/hour. #J...Remote jobContract work$47 - $65 per hour
...service team focused on prior authorization and pre-service utilization review. This role oversees day-... ...processes. Support the UM Pre-Service Director and... ...including when working remotely from another state.... ...the following: Medical, dental & vision Critical Illness...Remote jobContract workTemporary workMonday to Friday- ...Health System seeks a full-time Utilization Review Case Manager to work remotely. The role reviews patient charts for prior authorization, concurrent and retrospective utilization... ...will manage a caseload, communicate with clinicians and patients, and help minimize delays...Remote jobFull time
- ...Overview Title: Clinical Review Nurse – Prior Authorization Review Location: Fully Remote (PST Time Zone - WA/OR Resident) Duration: 12-Month (Potential for Extension) About the Role We are seeking an experienced Clinical Review Nurse for Prior Authorization...Remote workContract work
- ...About the job Remote Coverage Review Pharmacist Remote Coverage Review Pharmacist needs 3 years and Doctor of Pharmacy (PharmD... ...and appeals including the review of medication related prior authorizations, pharmacy appeals, and member grievances focused on medications...Remote workWork at office
- ...Behavioral Health Utilization Management Clinician Location Florida (Remote) Job Description This... ...medical necessity/utilization review and other utilization management... ...hospitalization and/or procedures, providing prior authorizations and/or concurrent review. The...Remote workWork at office
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Dental UM Clinician — Prior Authorizations and Reviews. Be the first to apply!
- software engineering manager remote Brooklyn, NY
- system engineer remote Brooklyn, NY
- remote technical project manager Brooklyn, NY
- remote recruitment consultant Brooklyn, NY
- remote property manager Brooklyn, NY
- remote reviewer Brooklyn, NY
- remote insurance agent Brooklyn, NY
- remote no experience Brooklyn, NY
- remote life underwriter Brooklyn, NY
- remote medical coding supervisor Brooklyn, NY


