Remote Pre-Authorization Nurse | Utilization & Care Decisions
Humana
- Remote job
Humana is looking for a Pre‑Authorization Nurse 2 to review prior authorization requests efficiently and ensure care appropriateness. This role involves interpreting policies, making independent decisions, and collaborating with necessary stakeholders. The ideal candidate must have a compact nursing license, three or more years of clinical nursing experience, and must reside in Oklahoma. The position offers opportunities for remote work, competitive benefits such as paid time off, 401(k) matching, and tuition assistance. #J-18808-Ljbffr Humana
$71.1k - $97.8k
...Become a part of our caring community. The Pre-Authorization Nurse 2 reviews prior authorization... .... Educate providers on utilization and medical management... ...operating standards. Make decisions regarding own work... ...technical difficulties in a remote environment. Ability to...Remote workBi-weekly payWork from home$71.1k - $97.8k
Humana Inc is seeking a Pre-Authorization Nurse 2 to join their remote team in Oklahoma. This role involves reviewing prior authorization requests for medical care and communicating with providers about utilization management processes. The ideal candidate will have a...Remote job- ...better health decisions. At AZ Blue, we... ...hybrid, onsite or remote. While the... ...completion of prior authorization (PA) requests... ...ensures all reviews utilize nationally... ...and Affordable Care Act (ACA) members... ...degree in Nursing Required Licenses... ...review process for pre-service...Remote workFull timeWork experience placementWork at office1 day per week
- ...A healthcare provider is seeking a Nurse Reviewer Supervisor in Cleveland, OH. The role involves overseeing prior authorization processes, supervising nursing staff, and ensuring... ...is available, combining onsite days with remote work, offering a dynamic environment and comprehensive...Remote work
- ...Description This is a remote position but will... ...guide every decision we make. Even when... ...to our mission: caring for every person... ...with physicians, nursing staff, and interdisciplinary... ...resource utilization and care planning... ...to denials and authorization changes by reviewing...Remote workFull timePart timeReliefWork at officeLocal areaShift workRotating shiftDay shift
- ...recruitment agency is seeking a Pre-Certification RN to evaluate clinical... ...necessity for services. This remote position requires an active RN... ...with a minimum of 3 years of acute care clinical experience. Responsibilities include authorizing services, ensuring compliance...Remote job
- ...Utilization Management Nurse RIHS Austin Regional Office - Austin, TX 78727... ...concurrent, retroactive and pre-service authorization reviews for inpatient and... ...with staff, physicians, care/service coordinators, and... ...This position is remote but requires the employee...Remote workFull timeWork at officeWeekend work
$35 - $45 per hour
...Registered Nurse (RN) | Utilization Review Location: Corpus Christi, TX... ...and will include 80% travel. Remote role. Will require a driver... ...and need for services for care plan development. Monitor... ...and telephonic contact Authorize and coordinate referral for...Remote workHourly payFull timeContract workImmediate startShift work3 days per week$34.98 - $42.85 per hour
...Utilization Management Nurse I, RN Huntington Beach Office - Huntington... ...Description Remote in California only... ...Who Are We? Clever Care was created to meet... ...clinical review of authorization requests to determine... ...Communicate authorization decisions to providers,...Remote workHourly payFull timeWork at office$60.2k - $107.4k
The Utilization Review Nurse, RN is responsible for providing clinically... ...review and or prior authorization requests for appropriate care and setting by... ...Medical Director for a decision. Required hours are 8... ...the flexibility to work remotely from anywhere within the...Remote jobMinimum wageFull timeWork experience placementLocal areaMonday to Friday$35 - $45 per hour
...Registered Nurse (RN) | Utilization Review Location: Corpus Christi, TX... ...and will include 80% travel. Remote role. Will require a driver... ...and need for services for care plan development. Monitor... ...and telephonic contact Authorize and coordinate referral for...Remote workHourly payFull timeContract workImmediate startShift work3 days per week- A health care recruitment agency is seeking a Recruitment Manager to assess and analyze... ...member benefits, and process prior authorizations. Candidates must have an Illinois state... ...medical clinic settings. This is a fully remote position, offering work within a collaborative...Remote work
$55.24 - $92.02 per hour
Utilization Review—RN US-Remote Requisition ID: 2026-39874 Position Category: Nursing - Care Management Job Type: ONA union represented... ...are met to secure authorization. Benefits... ...following: Reviews pre‑admissions for... ...on patient status decisions and other issues related...Remote workHourly payFull timePart timeWork at officeNight shiftWeekend work3 days per week- ...Quantum Corporation is seeking a Pre-Cert Pharmacy Review Nurse, RN for their healthcare navigation team. The role involves... ...multidisciplinary teams to ensure quality care for members, either on-site in Dublin, OH, or remotely within the United States. The ideal...Remote work
- ...Guidehealth leverages remotely‑embedded Healthguides™... ...are seeking a Clinical Care Manager who is... ...through precise and timely Utilization Review. In this role,... ...care, support provider decision‑making, and promote effective... ...aligned with Illinois nursing regulations and...Remote workBi-weekly payFull timeTemporary workFor contractorsLocal areaWork from home
- ...RN, Registered Nurse - Pre-Certification 3 days ago Be... ...our members get the care they need, when they... ...aspects of the prior authorization process for members of... ...the company such as Utilization Review, Patient Services... ...informed health decisions. Identify care coordination...Full timeWork at officeWork from home
$94.96k - $147.18k
Assistant Nurse Manager - Post‑op/PACU/Pre‑op Department/Unit: SCC (Ecmu... ...responsibility, authority, and accountability... ...delivery of patient care within the defined... ...accountability for decisions. Utilizes problem‑solving and... ...cannot be done from a remote location. Other...Remote workShift work- ...dedicated and detail-oriented Utilization Management Registered Nurse (UM RN) to join our... ...supporting transitions of care and ensuring patients receive... ...) . This is a fully remote opportunity requiring discipline... ...and process prior authorization (PA) requests in a timely...Remote work
- ...position Designation: Nurses – no nights, no... ...personalized managed health care, focused on what’s... ...Work‑life balance. Remote setting. Role... ...individual will utilize clinical knowledge... ...individual will defer decision to a second‑level reviewer... ...in completion of pre‑certification and...Remote workTemporary workWork at officeWork from homeMonday to FridayFlexible hours
$71.1k - $97.8k
...Job Summary The Utilization Management Registered Nurse uses clinical nursing skills to interpret... ...team manages post-acute care services, including... ...Experience working in a fully remote, metrics‑focused role. Experience... ...and baselines employment decisions on valid job requirements....Remote workBi-weekly payTemporary work- ...Description Title: RN – Registered Nurse Department Pool – Pre-op “We dedicate our lives to caring for yours” BayCare Health... ...their practice. Culture of safety Utilize the latest technology Benefits... ...Weekend Work Occasional On Call Yes Remote Work Never Equal Opportunity...Remote workReliefShift workWeekend work
$32.01 - $68.55 per hour
...about transforming health care. As the nation's... ...Position Summary This Utilization Manager position is... ...) team and is a fully remote role. Candidates must... ...New York Registered Nurse license. The employee... ...Experience with Prior Authorizations Knowledge of Medicaid...Remote workHourly payFull timeLocal area10 hours per weekFlexible hours$38.91 - $60.31 per hour
...Springs Department : MHC Pre OP Work Schedule: Full... ...not offer a hybrid or remote option Minimum... ...accredited or state board of nursing approved Registered/... ...practice in direct patient care utilizing the nursing process... ...making all employment decisions based on valid...Remote workFull timeTemporary workLocal areaFlexible hoursShift work$40 per hour
...Description Job Title: Utilization Management LPN... ...by reviewing authorization requests,... ...includes licensed nurses and utilization management... ...authorization decisions and status updates... ...continuity of care Meet established... ...independently in a remote environment...Remote workWeekly payPermanent employmentContract workTemporary workCasual workMonday to Friday$37.06 - $57.44 per hour
...not offer a hybrid or remote option Summary: Provides direct patient care at a proficient level,... ...Performs and documents pre/post procedure assessment... ...threatening situations utilizing nursing standards and protocols... ...stressful situations, reacting decisively with efficiency and...Remote workFull timeTemporary workLocal areaFlexible hoursShift work$38.91 - $60.31 per hour
...not offer a hybrid or remote option Minimum Requirements... ...or state board of nursing approved Registered/... ...practice in direct patient care utilizing the nursing process... ...up to $10,000/year pre-paid by UCHealth or up... ...making all employment decisions based on valid requirements...Remote workFull timeTemporary workLocal areaFlexible hoursShift work$26.35 - $39.53 per hour
...quality, coordinated care. By uniquely... ...Summary: The Concurrent Utilization Review (UR) Nurse is responsible for conducting... ...or level-of-care decisions. Collaborate with... ...in care. 3. Authorization & Payer Communication... ...office preferred / remote may be considered Collaborative...Remote workHourly payFull timeWork at office$38.91 - $60.31 per hour
...recent procedural/cath lab pre/recovery, PACU, or ED,... ...not offer a hybrid or remote option Summary:... ...direct patient care at a proficient level,... ...threatening situations utilizing nursing standards and protocols... ...situations, reacting decisively with efficiency and composure...Remote workTemporary workReliefLocal areaFlexible hoursShift workRotating shiftDay shift$34 - $35 per hour
...Utilization Management - Clinical Nurse - Work from Home! Utilization Management... ...requiring authorization. Conducts telephonic... ...requests Apply clinical decision-making to assess acuity... ...continuity of care Meet regulatory timelines... ...Authorization Remote Registered Nurse (Remote...Remote workFull timeWork at officeWork from homeNight shift$38.91 - $60.31 per hour
...not offer a hybrid or remote option Minimum Requirements... ...or state board of nursing approved Registered/... ...practice in direct patient care utilizing the nursing process... ...up to $10,000/year pre-paid by UCHealth or up... ...making all employment decisions based on valid requirements...Remote workTemporary workPart timeLocal areaFlexible hoursShift work
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