Remote RN: Prior Authorization & Utilization Review
IntelliResume
- Remote job
Humana seeks a Pre-Authorization Nurse to review prior authorization requests for appropriate care and setting, applying guidelines and policies. This role requires independent clinical judgment and strong decision-making abilities. Remote position from LA with a choice of schedules (Mon-Fri, Tues-Sat, or Sun-Thurs), 8-hour shifts. Active RN license in Louisiana and 2+ years RN experience are required; health plan or utilization management background is a plus. #J-18808-Ljbffr IntelliResume
- ...Humana seeks a Pre-Authorization Nurse to review prior authorization requests for appropriate... ...-making abilities. Remote position from LA with a... ...Thurs), 8-hour shifts. Active RN license in Louisiana and 2... ...required; health plan or utilization management background is a...Remote workShift work
- Position Summary: The RN Integrated Care Coordinator (UM... ...hours are required to address utilization review cases. Roles and... ...final determination. Conducts prior authorization, concurrent, and retrospective... ...Telecommuting Requirements This is a remote position. Our whole company...Remote workLive inFlexible hoursWeekday work
- ...Specialty Pediatrics* ICU MS Case Management/Utilization Review Pre-Cert Review* Prior Authorizations* Retrospective Review* Admission Criteria... .../National Safety Goals Additional Skills remote UR work CA and Medi-Cal experience/knowledge*Remote work
- ...care conditions. Reports to the Health Plan Manager of Utilization Management. This position will be an integral member of... ...Assists with the build and implements care management review processes (Prior Authorization, Predetermination, Concurrent Reviews, Retrospective Reviews...Remote workCasual workWork at officeShift work
- Molina Healthcare in Columbus, OH is seeking a Care Review Clinician to provide prior authorization for behavioral health services for the OH Medicaid population. The role requires strong BH care experience across inpatient, substance use, and outpatient services, plus...Remote job
- ...Utilization Review Nurse This position has a remote option for those living close and will be able to come into the... ...Others, or Leader of Leaders. The prior authorization role completes an assessment of... ...or compact required RN license in state of employment or...Remote workFull time
- ...Utilization Review Nurse Join our team at Cobalt Benefits Group and start... ...timely and effective care authorizations, transitions, and utilization... ...reviews for services requiring prior authorization, applying... ...Current, unrestricted RN license (State license required...Remote workFull timeTemporary workSummer workWork at officeFlexible hours
$71.1k - $97.8k
...The Hong Kong Study Skills Research Institute is seeking a Pre-Authorization Registered Nurse to join their team. This role involves reviewing prior authorization requests to ensure appropriate care while working from home. Ideal candidates will be licensed RNs with a...Remote workWork from home- ...Management Location: 100% Remote Schedule: M-F 9:00am... ...an Illinois state RN license Assess and analyze... ...eligibility Process prior authorization determinations within... ...Works with the Utilization Management team primarily... ...necessity/utilization review and other utilization...Remote workContract work
- Overview Title: Clinical Review Nurse - Prior Authorization Review Location: Fully Remote (PST Time Zone - WA/OR Resident) Duration... ...Review to join our Utilization Management team. In this role,... ...assigned Qualifications Active RN license (WA; must be in good standing...Remote workContract work
$26.41 - $51.49 per hour
...complact license.The Care Review Clinician will provide prior authorization for behavioral health... ...previous experience with Utilization Reviews.WORK SCHEDULE: Monday... ...schedule. This is a remote position. Home office... ...experience. • Registered Nurse (RN). License must be active...Remote workHourly payWork experience placementWork at officeHome officeMonday to Friday$45 - $50 per hour
Join Our Team as a Utilization Management RN - Make an Impact in Healthcare... ...outcomes. Whether working remotely or in a flexible hybrid setting... ...'ll play a key role in reviewing authorization requests, evaluating... ...Responsibilities Investigate prior authorization requests...Remote workHourly payWork at officeFlexible hours$35 - $40 per hour
...0/hr - $40.00/hr Location Fully Remote Position Summary The Utilization Review Nurse serves as a key liaison in... ...Responsibilities Review and process prior authorizations and reauthorization requests in... ...Current, active nursing license (RN, LPN, or LVN) in good standing...Remote workContract workFlexible hoursWeekend work- ...Care is looking to hire a Utilization Review Nurse The Utilization Review... ...Conducts primary functions of prior authorization, retrospective review,... ...Utilization Review Nurse, RN, Care Coordination, or Discharge... ...that are available as remote work, Sentara Health employs...Remote workTemporary workShift work
- ...: Manager of Clinical Utilization Management - Denial Compliance... ...Type: Hybrid (85% remote, 15% onsite in... ...daily tasks, performance reviews, and any necessary disciplinary... ...Nursing Program; RN preferred. 2. Minimum of five years in prior-authorization, appeals & grievance,...Remote workPermanent employmentFull timeTemporary workFlexible hours
- ...service requests, verify member benefits, and process prior authorizations. Candidates must have an Illinois state RN license and 1-3 years of experience in hospital or medical clinic settings. This is a fully remote position, offering work within a collaborative...Remote work
$48 - $65 per hour
...Remote Registered Nurse – Clinical Review Fully Remote | $48–$65/hr | Monday–Friday, 9:00 AM–6:00 PM ET... ...when needed. The work can touch prior authorization, utilization review, care coordination,... ...What we’re looking for ~ Active RN license ~ BSN preferred ~3+...Remote workLong term contractMonday to Friday$65k - $78k
...development. Your Role In Our Mission Review admissions, procedures, services, and... ...on clinical guidelines. Maintain RN license and meet continuing education requirements... ...clinical experience. ~1+ year in prior authorization reviews using InterQual or MCG. ~...Remote workFull timeWork at officeWork from homeFlexible hours- ...Job Description: Ascension Texas Utilization Management Department (Fully Remote)Job Summary:• Provides health care services regarding admissions, case management, discharge planning and utilization review.Responsibilities:• Reviews admissions and service requests within...Remote work
- ...United States is seeking an Inpatient Utilization Management Clinician to evaluate... ...across care teams. This fully remote, full-time role requires an active RN license, nursing degree, and experience... ...care management to ensure timely reviews, document outcomes, and maintain...Remote workFull time
$30 - $38 per hour
...A healthcare organization is seeking a part-time Utilization Review Nurse RN to conduct assessments and reviews for medical necessity of treatment requests. This role involves working 28 hours per week with responsibilities such as providing reviews for pre-certification...Remote workHourly payPart time- ...RN Utilization Review Review patient medical records to assess the appropriateness and medical necessity of hospital admissions, continued... ...management experience (hospital-based) ~ Skilled experience with remote work Length of assignment: 13 weeks Shift / hours...Remote workShift workWeekend work
- ...Providing timely and evidence-based utilization review services, the full-time Utilization Review RN will work remotely to manage complex medical conditions, treatment planning, and recovery for injured employees while advocating for effective medical treatment. Key responsibilities...Remote workFull timeWork experience placement
$72.8k - $130k
...occasional opportunity for remote work based on... .... As a Sr Utilization Management Nurse... ...discuss care details, reviewing clinical... ...review of current and prior patient conditions... ...Registered Nurse (RN) with a current, active... ..., including prior authorization, concurrent...Remote workMinimum wageFull timeWork experience placementCasual workLive inWork at officeLocal area$65 per hour
...Fully Remote Position Job Title : RN - UTILIZATION REVIEW Location: Everett, WA 98201 Start Date: 05/04/2026 Duration: 13 weeks Schedule Shift: Day 5x8-Hour (08:00 - 16:30) Shift Notes: Days (5×8) | 08:00 - 16:30PAY DETAILS (72 HOURS / 2 WEEKS)...Remote workLocal areaImmediate startMonday to FridayShift workWeekend work- ...WNS, part of Capgemini, seeks a remote Utilization Review Nurse to perform medical necessity reviews and collaborate with providers to ensure compliant... ...team-oriented environment. Requirements include active RN or LVN licensure, a minimum of two years in utilization...Remote workWork at office
- ...Overview This remote position in Utilization Management requires a Registered Nurse with 2 years of experience. Responsibilities include working with providers, managing reviews, and utilizing EMR systems. The role follows a Monday through Friday schedule with...Remote workWeekly payMonday to FridayWeekend work
- ...To support a mission-driven health organization, the full-time Utilization Review Nurse - RN will conduct medical necessity reviews, escalate non-certifications for secondary clinical review, and analyze clinical records to ensure timely and compliant care determinations...Remote workFull time
- ...Utilization Management RN Remote I'm currently working on a Utilization Management RN opportunity with a health plan client, supporting... ...fully remote in EST hours. This position will be reviewing prior authorization requests, assessing medical necessity and benefit...Remote workContract workTemporary workMonday to FridayShift work
- ...role at a glance Location: Remote Department: Ascension Care Management Insurance - Utilization Review Schedule: Day Shift |... ...~ Registered Nurse obtained prior to hire date or job transfer... ...job application through our authorized applicant tracking system....Remote workReliefLocal areaDay shift
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