Remote RN: Prior Authorization & Utilization Management
Central California Alliance for Health (Remote)
- Remote job
Central California Alliance for Health is seeking a Part Time Prior Authorizations Nurse (RN) for a temporary assignment based remotely in California. The role reports to the Utilization Management Supervisor and supports the UM Care Programs. The position offers 20–40 hours per week, Monday–Friday, with no guaranteed benefits for temporary staff. The ideal candidate will hold a CA RN license and have knowledge of managed care, CMS guidelines, and experience in utilization management. #J-18808-Ljbffr Central California Alliance for Health (Remote)
- ...Intermountain Health is seeking an RN Utilization Review Care Management I for a fully remote, part-time role. The position covers enterprise-wide shifts... ...service area. Responsibilities include reviews, prior authorizations, and collaboration with providers to ensure...Remote workPart timeShift workWeekend work
$70.2k - $120.4k
...every member feels valued.The Utilization Review RN will review and document... ...reviewing and documenting prior authorization requests and member case... ...policies and utilization management and/or clinical appeals policies... ...position is a Remote role. To be eligible for consideration...Remote workWork experience placement$39 - $40 per hour
...Healthcare Recruiter at The Judge Group Utilization Management Registered Nurse (RN) Type: 6-Month Contract W2 Location: Remote - but MUST reside in one of the... ...Utilization Management RN experience, including Prior Authorization and Concurrent Review Experience...Remote workDaily paidContract workMonday to FridayShift workWeekend work- ...meet their care conditions. Reports to the Health Plan Manager of Utilization Management. This position will be an integral member of... ...build and implements care management review processes (Prior Authorization, Predetermination, Concurrent Reviews, Retrospective Reviews...Remote workCasual workWork at officeShift work
$75k - $100k
...Utilization Management RN (Registered Nurse) evaluates efficiency, appropriateness... ...evidence-based criteria, authorize requested services as appropriate... ...Location We are open to remote work in the following... ...medical and behavioral health prior authorization requests for...Remote workFor contractorsWork at officeLocal areaImmediate start- Pyramid Consulting is seeking an Utilization Management RN for a 12+ month contract opportunity with a remote location in the United States. The role focuses on prior authorization, clinical document review, and timely case management. Strong nursing credentials and IRN...Remote jobContract workImmediate start
- CVS Health is seeking an experienced Utilization Management Nurse Consultant (RN) to support prior authorization decisions remotely. You will review requests, determine medical necessity, and apply clinical criteria to ensure efficient, cost-effective care. Collaboration...Remote job
- ...an experienced Registered Nurse for a remote Utilization Management role. You will review cases, assess medical necessity, and support prior authorization decisions while collaborating with... ...teams. The ideal candidate has 3+ years RN experience, ADN required with BSN...Remote job
- ...experienced nurse leader in Oklahoma for a remote role overseeing Prior Authorization, Concurrent Review, Retrospective... ...The position requires an active RN license and supervisory... .... The ideal candidate will guide utilization management, coordinate with providers, and ensure...Remote workWork at office
- ...Centene Corporation in Oklahoma City seeks an experienced RN to lead the Prior Authorization, Concurrent Review, Retrospective Review, and Appeals teams, ensuring compliant utilization management. This role oversees UM processes, guides standards, analyzes utilization...Remote workWeekend work
- WPS Health Solutions seeks an experienced Utilization Management Registered Nurse (UM RN) to evaluate efficiency, appropriateness, and medical necessity... ...teams, and other departments while reviewing prior authorization requests and ensuring alignment #J-18808-Ljbffr WPS...Remote job
- CVS Health is seeking an experienced Utilization Management RN to review prior authorization requests across multiple specialties and determine medical necessity... ..., and managing a high-volume caseload from a remote home office. The ideal candidate holds an active multi...Remote jobHome office
- WPS Health Solutions is seeking an Utilization Management RN to evaluate medical necessity and appropriate... ...in the future. The position offers remote work options with a competitive... ...to candidates in multiple states. Prior authorization and utilization review experience are...Remote job
- Central California Alliance for Health is seeking a Prior Authorizations Nurse (RN) for a temporary, full-time role. This remote-in-California position reports to the Utilization Management Supervisor and involves ensuring PA requests comply with contracts and evidence-...Remote jobFull timeContract workTemporary work
- ...Community) Is a Non-profit Managed Care Organization (MCO),... ...Summary Behavioral Health Utilization Manager will perform... ...facility contract status prior to processing authorization requests. Complies with established... ...Work Schedule: Remote Other Requirements...Remote workContract workWork experience placement
$35 - $40 per hour
...offerings for clinical, case management, member engagement,... ..., and analytics. Job Title RN Utilization Management Reviewer Responsibilities... ...for services requiring prior authorization in a variety of clinical areas... ...weekends. Location: Fully remote work at home role. Secure,...Remote workHourly payTemporary workMonday to FridayFlexible hoursWeekend work$35 - $40 per hour
Sagility LLC, a leader in healthcare transformation, seeks an RN Utilization Management Reviewer for a fully remote role. You will perform timely clinical decision reviews for services requiring prior authorization across various clinical areas, applying criteria like...Remote jobHourly pay$38 - $40 per hour
Utilization Management RN - Prior Authorization Immediate need for a talented Utilization Management RN - Prior Authorization. This is a 12+ Months Contract... ...with long-term potential and is located in US (Remote). Job ID:26-31179 Pay Range: $38 - $40/hour. Employee...Remote workContract workWork at officeLocal areaImmediate start$72.8k - $130k
...occasional opportunity for remote work based on... ...needs. As a Sr Utilization Management Nurse in the Springfield... ...review of current and prior patient conditions,... ...a Registered Nurse (RN) with a current, active... ...UM, including prior authorization, concurrent authorization...Remote workMinimum wageFull timeWork experience placementCasual workLive inWork at officeLocal area$68k - $120.5k
...of Specialty and Payer Management, the Clinical Reviewer... ...necessity reviews, authorization compliance, reimbursement... ...reimbursement and utilization management to reduce denials... ..., case management, prior authorization, revenue... ...Type Staff Work Model Remote Background Check...Remote workFull timeWork at office- ...CVS Health in the United States is seeking an experienced Utilization Management Nurse Consultant (RN) to join our remote team. You will review prior authorization requests, evaluate medical necessity, and apply clinical criteria to support timely, cost-effective care...Remote work
- ...NeueHealth is seeking a Utilization Management Nurse (LVN/LPN) for a remote role based in California. The position focuses on reviewing prior authorizations, ensuring alignment with coverage policies and medical necessity, and collaborating with providers, patients, and...Remote work
$26.01 - $62.32 per hour
...one family and one community at a time. RN Utilization Management Nurse Consultant (Medicare - Joint Procedures) Remote | Full-Time | Monday-Friday (9:00 am to 5:... ...Nice to Have Utilization Management or Prior Authorization experience Managed care and/or Medicare...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeMonday to FridayAfternoon shiftWeekday work$27.1 - $40.65 per hour
...are committed to transforming healthcare and creating a better care experience for all. JOB SUMMARY The Utilization Management (UM) Prior Authorization (PA) Nurse is a full-time role with NeueHealth, dedicated to promoting quality and cost-effective outcomes for...Remote workHourly payFull timeContract workWork at officeWork from home$29.1 - $62.32 per hour
...family and one community at a time. Utilization Management Nurse Consultant - Clinical Precertification RN (Medicare) Remote | Full-Time | Monday-Friday What You... ...judgment to utilization management and prior authorization decisions Identify opportunities to...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeMonday to FridayAfternoon shift$54.1k - $116.77k
...one family and one community at a time. Utilization Management Nurse Consultant Clinical Precertification RN Remote | Full-Time | Weekday Schedule Are you... ...Qualifications Utilization Management or Prior Authorization experience Managed care background Ambulatory...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeMonday to FridayAfternoon shiftWeekday work$26.01 - $56.14 per hour
...family and one community at a time. Utilization Management Nurse Consultant Clinical Precertification RN (Medicare- Complex Spine Team) Remote | Full-Time | Weekday Schedule... ...Have Utilization Management or Prior Authorization experience Managed care background...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeMonday to FridayAfternoon shiftWeekday work$29.1 - $62.32 per hour
...partner company, who manages all applications and next... ...is looking for a Utilization Management Nurse Consultant... ...Nurse to join a remote Utilization Management... ...contribute to effective prior authorization decisions, improved healthcare... ...Registered Nurse (RN) license in the state...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeMonday to FridayAfternoon shift- ...The primary role of the Utilization Management Nurse is to review and monitor... ...procedures. This includes providing prior authorizations, concurrent review,... .... This is primarily a remote telephonic position with normal... ...years clinical experience as RN, LPN/LVN required....Remote workContract workWork at officeWeekend work
$60.53k - $129.63k
...one family and one community at a time. Utilization Management Nurse Consultant Clinical Precertification RN (Medicare) Remote | Full-Time | Weekday Schedule Are... ...for conducting utilization management and prior authorization reviews to ensure members receive medically...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeMonday to FridayAfternoon shiftWeekday work
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote RN: Prior Authorization & Utilization Management. Be the first to apply!
- kaiser rn San Francisco, CA
- outpatient rn San Francisco, CA
- sedation rn San Francisco, CA
- 1099 rn San Francisco, CA
- ed rn San Francisco, CA
- registered nurse office San Francisco, CA
- labor & delivery rn San Francisco, CA
- registered nurse remote San Francisco, CA
- injection rn San Francisco, CA
- gastroenterology rn San Francisco, CA


