Remote RN: Prior Authorization & Utilization Review
IntelliResume
- Remote job
Humana is seeking a Pre-Authorization Registered Nurse for a remote, full-time role based in Virginia. The RN will review prior authorization requests, determine appropriate care settings, and educate providers on utilization and management processes. Requirements include an active RN license in VA or an eNLC-participating state, plus at least two years of varied clinical nursing experience in acute, skilled, or rehabilitation settings. Compensation aligns with market ranges. #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
$1,949.74 per month
...Nurse Specialty Utilization Review Job ID 17979666... ...Title Utilization Review RN Weekly Pay $1949... ...Job Description Remote Utilization Review RN responsible... ...necessity determinations, prior authorizations, continued stay reviews,...Remote workWeekly payShift 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
- ...by Specialty Pediatrics* ICU MS Case Management/Utilization Review Pre-Cert Review* Prior Authorizations* Retrospective Review* Admission Criteria Care... ...Measure/National Safety Goals Additional Skills Remote UR work CA and Medi-Cal experience/knowledge*...Remote work
$1,908 per month
...Registered Nurse Specialty Utilization Review Job ID 17789408... ...Utilization Review Pre-Cert Review* Prior Authorizations* Retrospective Review* Admission... ...Safety Goals Additional Skills remote UR work CA and Medi-Cal experience...Remote workWeekly payShift workNight shift- ...Utilization Review Nurse Location: [City, State / Remote] Employment Type: Full-Time Experience... ...Registered Nurse (RN) with experience in... ...party payers regarding authorization and coverage determinations... ...methodologies and prior authorization processes...Remote workFull timeSecond jobWork at office
- ...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
- ...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
$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- 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
$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- ...: 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
$28 per hour
LPN Utilization Management Nurse Reviewer Miami, FL (Work from Home position for FL residents... ...plan of care Provide authorizations and notifications in a... ...DME: 1 year (Required) prior authorization UM review:... ...Required) Work Location: Remote #J-18808-Ljbffr Coastal...Remote workHourly payFull timeWork at officeLocal areaWork from homeRelocationHome officeWeekday 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- ...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
$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- ...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- ...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
- ...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
- ...Job Title In this remote role, you will perform utilization reviews, ensuring compliance with clinical guidelines and patient care standards. Collaborate with interdisciplinary teams to assess patient needs and facilitate care coordination. Your expertise in medical...Remote workWeekly pay
- ...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
- ...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
$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- ...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
$45 - $50 per hour
...for a dedicated Registered Nurse Clinical Reviewer for a fully remote position in New York. This role involves conducting utilization and quality reviews and contributing to clinical... ...of accredited nursing programs with an active New York RN license. #J-18808-LjbffrRemote workHourly pay- ...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
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