Remote RN: Prior Authorization Clinical Reviewer
Centene Corporation
Centene Corp. is looking for a Clinical Review Nurse - Prior Authorization to work remotely. This position entails analyzing prior authorization requests to determine medical necessity, working with healthcare providers for timely reviews, and maintaining compliance with regulatory guidelines. Applicants must have an active New York State RN licensure and a degree from an Accredited School of Nursing, with 2-4 years of related experience preferred. The role follows a Monday–Friday schedule from 8:30 AM to 5:00 PM ET. #J-18808-Ljbffr
- ...Acentra Health, LLC is seeking a Clinical Reviewer of Behavioral Health to... ...contract requirements. This remote position requires work aligned... ...have an active Virginia RN or LMHP license and at least 1 year of experience in Prior Authorization or Utilization Review. Acentra...Remote workContract work
$28.37 - $36 per hour
...through technology, services, and clinical expertise. Our mission is to innovate... ...Health is looking for a Clinical Reviewer - RN - PRN (Remote U.S.) to join our growing team.... ...Utilization Management (UM), OR Prior Authorization. ~1+ years of knowledge of InterQual...Remote workContract workWork experience placementReliefWork at officeLocal areaMonday to FridayFlexible hours- ...this position is to utilize clinical expertise to review medical records against... ...requirements. Location: Remote (U.S.-based) Licensure Requirement... ...unrestricted LPN/LVN or RN license in Indiana or... ...Management (UR/UM) and/or Prior Authorization experience ~2+ years of...Remote workContract workWork at officeMonday to FridayWeekend workWeekday work
$80k
...Liberty Healthcare Corporation Career Center is looking for a full-time Clinical Reviewer to join their team. This remote-first role involves reviewing medical records, conducting analyses, and writing objective reports. In addition to a competitive annual salary of $8...Remote workFull time- ...Q-Centrix is seeking a Senior Clinical Data Specialist to join our team in Chicago, focusing on delivering quality solutions to healthcare... ...in MS Office, and hold active SCR certification along with RN credentials. We value critical thinkers who can thrive independently...Remote work
- ...A national nonprofit organization is seeking a Registered Nurse (RN) to perform Clinical Review work and QIDP reviews. This remote position requires an active RN license in Alabama and at least three years of direct patient care experience. Key responsibilities include...Remote work
- ...Position Overview We are seeking an RN to perform Clinical Review work and QIDP reviews work. Team member will serve as the QIDP (.5 FTE) and as... ...Requirements & Work Environment This position is primarily remote and performed in a home-based setting, requiring reliable...Remote workContract work
$50 per hour
...Overview RN Clinical Reviewer / IDR - Remote (#25310C) Location: Remote Employment Type: Full-time Hourly Rate: $50/hr Position Overview Greenlife Healthcare Staffing is seeking an experienced Registered Nurse Clinical Reviewer (IDR) to join a remote position at a non-...Remote workHourly payFull timeWork at officeFlexible hours$50 per hour
...A leading healthcare staffing firm is seeking an experienced RN Clinical Reviewer to work remotely. You'll conduct detailed medical-legal reviews and appeals while maintaining high accuracy and integrity. Key qualifications include a New York State RN license and at least...Remote work- ...A health organization is seeking a Registered Nurse (RN) to perform clinical review and QIDP work remotely. The ideal candidate will assess medical necessity according to Alabama Medicaid guidelines and possess a current RN license in Alabama, along with a BA/BS in Nursing...Remote work
- COMAGINE HEALTH is seeking a registered nurse for Clinical Review and QIDP responsibilities, working remotely from any U.S. location. The role requires an active RN license in Alabama, a BA/BS in Nursing, and at least three years of direct patient care experience. Responsibilities...Remote jobWork from home
$28.37 - $35 per hour
...through technology, services, and clinical expertise. Our mission is to... ...Acentra seeks a Clinical Reviewer to join our growing team.... ...Active, unrestricted LPN or RN license in the applicable state... ...of one year UR and/or Prior Authorization or related experience. Requires...Remote workContract workWork at officeLocal areaMonday to FridayFlexible hoursShift workWeekend work$57 per hour
ProPivotal Staffing is seeking a Clinical Pharmacist Reviewer to work from home in Massachusetts. This role supports clinical pharmacy services and involves optimizing treatments with healthcare teams. Candidates should have 1-2 years of experience and an active Massachusetts...Remote workHourly payWork from homeFlexible hours- TEEMA Solutions Group is looking for a Clinical Quality Reviewer to support a large-scale federal healthcare... ...ideal candidate will have an active RN or LCSW license, at least 3 years of... ...skills. This role offers flexibility with remote or onsite work options, depending on...Remote job
- ...Registered Nurse with active licensure and minimum 3 years of clinical experience for a remote position. Candidates must have strong clinical... ...eligible for DoD background clearance. This role involves reviewing medical records, identifying quality issues, and supporting...Remote job
$50 per hour
...Staffing is looking for an experienced Registered Nurse Clinical Reviewer for a fully remote position with an hourly rate of $50. This role involves conducting... .... Candidates should have an active New York State RN license and 1-3 years of experience in acute care...Remote jobHourly pay$40 - $45 per hour
...per week (Mon - Fri) Location : Remote Summary : The Clinical Reviewer is responsible for conducting clinical reviews of submitted prior authorization (PA) requests and pre-payment... ...Licensed clinician (e.g., MD/DO, PA, NP, RN) At least 5 years of professional...Remote workHourly payPart timeFor contractorsWork at officeLocal area$85k - $92k
TEEMA Solutions Group is seeking a Clinical Quality Reviewer to support a federal healthcare program. This... .... Candidates must have a valid RN or LCSW license with at least three years... ...clinical experience. The position may be remote or onsite based on business requirements...Remote jobWork at officeHome office- Acentra Health is seeking a remote Registered Nurse (RN) or Licensed Mental Health Professional (LMHP) for a position that involves reviewing medical records and ensuring compliance... ...license in Virginia and experience in Prior Authorization or Utilization Review. The job...Remote jobContract work
$85k - $92k
...Hourly Equivalent: ~$41-$44/hr Location: Remote Schedule: Must work AZ hours (... ...HAVE) Active, unrestricted license: RN Minimum 3+ years clinical experience (med/surg and/or behavioral... ...DESIRED) Clinical Quality / Utilization Review / Case Review experience Experience...Remote jobHourly payDay shift- ...Comprehensive Cancer Centers of Nevada is seeking a Clinical Insurance Reviewer to work remotely in the Southern Nevada area only. The Clinical Reviewer... ...guidelines for clinical staff Obtains insurance authorization and pre‑certification for imaging, pulmonology and surgical...Remote workWork at office
- ...federal healthcare program to identify a Clinical Quality Reviewer. This role focuses on reviewing... ...unrestricted license as a Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW... ...-driven environment Other Information Remote or onsite depending on business needs Must...Remote workWork at officeHome office
$50 - $52 per hour
Claims Clinical Documentation Reviewer Schedule: 5-10 hours per week. Resource can work... ...weekends if they prefer. Remote position. Equipment is... ...FPCC. Knowledge Service Authorization concepts, principles, and... ...design and implementation, prior authorization functions and...Remote workPart timeWork at officeLong distance10 hours per week- ...recruiting firm is seeking qualified candidates for a remote RN or LCSW position. Candidates should have at least 3 years of clinical experience in med/surg or behavioral health,... ...clearance. Responsibilities include reviewing medical records, identifying potential quality...Remote job
- ...quality improvement, and better health outcomes. Our remote workforce collaborates across the country to deliver meaningful... ...Analysis (ABA) Consultant to support a Medicaid Prior Authorization (PA) program reviewing ABA therapy services. In this role, the consultant...Remote workRelief
$28.37 - $38 per hour
...through technology, services, and clinical expertise. Our mission is to... ...looking for a PRN Clinical Reviewer - Substance Use (LPCC, LMFT,... ...needed). The role is also remote within the United States but... ...Management (UM) OR Prior Authorization. ~ In-depth understanding...Remote workContract workReliefWork at officeLocal area$50 per hour
...healthcare recruitment agency is seeking a Registered Nurse Clinical Reviewer for a remote to office-based position in Jericho, NY. This role involves... ...has a baccalaureate degree in Nursing and a current NY RN license with at least 3 years of related experience. Competitive...Remote jobWork at office$28.37 - $39.19 per hour
...through technology, services, and clinical expertise. Our mission is to... ...impact. Job Summary Clinical Reviewer - Substance Use - LPCC, LMFT, LICSW - PRN (Remote U.S.) Responsible for... ...Utilization Management (UM) or Prior Authorization experience. In-depth understanding...Remote workHourly payContract workReliefWork at officeLocal area- ...Avita Health System is hiring a Clinical Documentation Specialist - Nursing (RN) to enhance clinical documentation quality at Avita Ontario Hospital. This full-time position primarily operates remotely, with some required in-person training and physician collaboration....Remote workFull time
$110k - $140k
...Clinical Quality Reviewer - BCBA Onos Health's mission is simple but ambitious: ensure every healthcare... ...management, care review, or prior authorization review for a payer or managed care organization... ...office (Financial District), remote-first culture Unlimited vacation...Remote workWork at officeHome officeFlexible hours2 days per week3 days per week
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