Utilization Management RN - Prior Authorization

Utilization Management RN - Prior Authorization

Immediate need for a talented Utilization Management RN - Prior Authorization. This is a 12+ Months Contract opportunity with long-term potential and is located in US (Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID:26-31179 Pay Range: $38 - $40/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Prioritize assigned cases based on urgency and turnaround time.
• Review clinical records against applicable criteria and benefits, documenting findings accurately.
• Communicate requests for missing information and escalate cases outside nursing authority.
• Participate in team huddles, respond to inquiries, and complete administrative tasks.
• Measure performance through quality and documentation accuracy, productivity, and adherence to policies.

Key Requirements and Technology Experience:

• Required: Graduate from an Accredited School of Nursing or bachelor's degree in nursing.
• 2+ years of clinical nursing experience; experience in utilization management, managed care, or prior authorization is preferred.
• Required: Active RN licensure.
• Strong critical thinking, organization, attention to detail, and professional communication skills.
• Proficiency with electronic clinical systems, Microsoft Office, and remote collaboration tools.
• Experience in case management within required turnaround times.
• Familiarity with medical-necessity criteria and clinical documentation standards.

Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions.