Utilization Management RN: Prior Authorization Specialist
NeueHealth
NeueHealth is seeking a Utilization Management Prior Authorization Nurse to ensure appropriate benefit coverage and evidence-based care for assigned populations. You will collaborate with Medical Directors and clinicians to review authorizations for treatments, medications, and tests, while tracking utilization data and maintaining quality standards. Qualified candidates hold a California RN license, with 2+ years in utilization management or related fields. #J-18808-Ljbffr NeueHealth
- University of Miami 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, coordinating with the care team for timely and appropriate care. You...SuggestedRemote jobFull time
- ...Humana Healthy Horizons in Kentucky seeks a Utilization Management Behavioral Health Professional 2 to support coordination, documentation, and communication of medical services and benefit determinations. The role requires interpreting criteria and policies with independent...Suggested
$50k
...Employer Industry: Behavioral Healthcare Management Why consider this job opportunity Starting pay up to $50... ...What to Expect (Job Responsibilities) Complete pre-authorizations, concurrent reviews, and internal utilization review assessments Consult with the...SuggestedRemote work- ...nationwide Position Summary The PAHub & Prior Authorization Specialist serves as a trusted consultant to... ...operations, implementation, account management, training, and support. The ideal... ...Adoption & Optimization Assess customer utilization of PAHub and identify opportunities...SuggestedLocal areaRemote work
- We’re seeking a dedicated and detail-oriented Utilization Management Registered Nurse (UM RN) to join our growing healthcare team. In this role, you... ...-based criteria (e.g., MCG). Evaluate and process prior authorization (PA) requests in a timely, compliant manner....SuggestedRemote work
- ...seeking an Appeals and Grievances Clinical Specialist to manage member complaints and clinical case... ...This is a 100% remote role requiring an RN, LPN, or Dental Hygienist license.... ...in clinical practice and knowledge of Utilization Review Guidelines. The position offers...Remote work
$85k - $120k
...seeking a Scheduler/ Project Controls Specialist - Utilities to join our team in Binghamton, NY.... ...databases and reports for projects. Manage and ensure the reconciliation of program... .../or MS Project experience required. Prior experience in substations, transmission...Full timeTemporary workWork at officeFlexible hours$35 - $37 per hour
...Group. Job Title: Remote Registered Nurse (RN) - Temp to Perm Pay Rate: $36-37/hr Start Date... ...(3+ years at the same facility) either prior to or after their travel assignments. No NPs, whether practicing or not. Utilization Review experience is helpful but not required...Remote jobPermanent employmentFull timeTemporary workMonday to Friday- A healthcare staffing agency is seeking a Utilization Management RN to work remotely from PA, DE, or NJ. The role involves assessing clinical information, determining medical necessity for services, and collaborating with providers. Candidates should have at least three...Remote jobFlexible hoursWeekend workDay shift
$45 - $45.5 per hour
Overview Job Title: Nurse Case Management Senior Analyst Location: REMOTE Duration: 5-6 Months... ...with the physician treatment plan. Utilizes clinical skills to assess, plan, implement... ...escalated from more junior team members. RN and current unrestricted nursing license...Contract workImmediate startRemote workMonday to FridayAfternoon shift- OOS Management Corp. is looking for a meticulous Authorizations Specialist in New York City. You will be responsible for submitting and tracking prior authorization requests to insurance companies, helping our therapists and BCBAs serve families effectively. The ideal...
$93.4k - $116.8k
...following VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare... ...needed. Conducts review of requests for prior authorization of health services, as required in certain... ...or related area such as medical or utilization management requiredProficient verbal/...Work experience placementWork at officeFlexible hours- ...healthcare costs through intelligent data management, pharmacy optimization, and value... .... Job Overview: The Intake Specialist is responsible for managing... ...all required elements are obtained prior to benefits investigation and authorization Conduct welcome calls to patients...Work at officeRemote work
$80k - $120k
...Expert, Care Team Operations (RN) Remote Thesis is... ...clinical operations and care management activities for healthcare organizations... .... This is a broad-scope "utility player" role for a clinician... ...gap outreach to complex prior authorizations and clinical documentation...Remote work- A healthcare staffing agency seeks a Utilization Management RN to evaluate clinical conditions through medical record reviews. The position is remote, requiring candidates to reside in PA, DE, or NJ. Key duties involve applying criteria for medical necessity, collaborating...Remote job
- CVS Health is seeking an experienced Utilization Management Nurse Consultant for a 100% work-from-home role in the EST time zone. The position supports... ...management and benefit coordination, requiring an active RN license and hospital experience. Responsibilities include...Remote jobWork from home
- Appworkshub is seeking a dedicated and detail-oriented Utilization Management Registered Nurse (UM RN) to join our remote healthcare team. In this role, you will conduct inpatient and outpatient utilization reviews, support transitions of care, and ensure compliance with...Remote job
- IntusCare is seeking a Utilization Management (UM) Manager to lead the UM nurse team supporting a PACE program. You will own end-to-end UM delivery, ensure SLA compliance, and apply clinical decision support criteria across cases to optimize care and efficiency. The role...Remote job
- ...Associate Vice President, Space Planning & Utilization About the Company Acclaimed clinical research & medical care center Industry... ...to senior leadership, collaborating with key partners, and managing the specific space needs of the institution's various schools...
$168.5k - $198.33k
...- and we’re just getting started.Key ResponsibilitiesAccount Management: Manage a personal book of business and serve as the primary day... ...insights and actionable recommendations to merchants by utilizing internal data visualization tools.Strategic Collaboration: Coordinate...Contract workWork at office3 days per week- SKYGEN in the United States is seeking a detail-oriented auditor to review authorization case work and provide technical support for processing to meet SLAs and regulatory requirements. You will perform daily and monthly audits, communicate findings, and collaborate with...Remote jobPermanent employment
$83k - $120k
...all regulatory requirements. Utilization Review & Triple-Check Coordination... ...medical necessity, track managed care authorizations, and ensure accurate billing alignment prior to transmission. Audit Readiness... ...unrestricted Registered Nurse (RN) license in the state of...Full timeTemporary workPart timeWork at officeImmediate startFlexible hoursShift work$118.13k - $155.79k
New York-Presbyterian Hospital is seeking a Case Manager - RN for Inpatient Units. This full-time position involves discharge planning and utilization management for patients in Brooklyn Methodist. Responsibilities include managing clinical reviews and coordinating post...Full time$64.25k - $72k
...trimming trees — we’re building a future. As the second-largest utility vegetation management company in North America and a proud employee-owned... ...Plan (ESOP)! Responsibilities What You’ll Do as a Safety Specialist Serve as a visible leader, influencing and motivating...ApprenticeshipLocal areaNight shiftDay shift$20 - $30 per hour
A behavioral healthcare organization is seeking a Utilization Review Specialist to conduct clinical auditing and negotiate authorizations. The ideal candidate has a Bachelor's degree in Social Work or Nursing and 1-2 years of healthcare experience. Responsibilities include...$50 - $59 per hour
...Asset Management SpecialistCAI is a global services firm with over 9,000 associates worldwide... ...for a motivated Asset Management Specialist ready to take us to the next level! If... ...conduct repetitive tasks on a computer, utilizing a mouse, keyboard, and monitorAbility to...Full timeContract workApprenticeshipWork at officeLocal areaWorldwide- SUNY Downstate Health Sciences University is seeking a full-time TH Utilization Review Quality Assurance Senior Coordinator / RN Case Manager in New York. The role focuses on hospital case management, utilization review, and discharge planning to ensure smooth transitions...Full time
- ...Osmose Utilities is seeking to fill multiple Safety Specialist1 roles... ...and safety team, the Safety Specialist I will work/travel within... ...and support the Osmose Safety Management Program. On a daily basis,... ...travel. Responsibilities Must be authorized to work in US without...For subcontractorLive inNight shift
$50 - $59 per hour
...Asset Management Specialist New York, New York, United States IT Asset Analyst IT Asset Manager Systems Analyst Configuration Engineer... ...locations Ability to conduct repetitive tasks on a computer, utilizing a mouse, keyboard, and monitor Ability to lift and move...Hourly payFull timeContract workApprenticeshipWork at officeLocal areaWorldwide$20 per hour
...Description Concern Housing is seeking a certified Peer Specialist to work with our Crisis Incident Stress Management (CISM) team to provide support to tenants across... ...and responded to in ways that fully develop and utilize each person's talent and strengths. EOE Statement...Daily paidInternshipLive inLocal areaFlexible hoursDay shiftAfternoon shift
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