Remote RN: Prior Authorization & Utilization Management
CVS Health Corporation
- Remote job
CVS Health Corporation is seeking an experienced Utilization Management Nurse Consultant (RN) for remote work. You will review prior authorization requests, evaluate medical necessity, and apply clinical criteria to support timely, cost-effective care. Collaboration with providers and care teams is essential to ensure quality outcomes. The role requires an active multi-state RN license, 3+ years of clinical nursing, and 2+ years in utilization management or related areas. #J-18808-Ljbffr CVS Health Corporation
$72.8k - $130k
...occasional opportunity for remote work based on... ...needs. As a Sr Utilization Management Nurse in the Springfield... ...of current and prior patient conditions, documents... ...a Registered Nurse (RN) with a current,... ...UM, including prior authorization, concurrent authorization...Remote workMinimum wageFull timeWork experience placementCasual workLive inWork at officeLocal area- 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... ..., and educate providers on utilization and management processes. Requirements include an...Remote jobFull time
- ...Utilization Management RN Remote I'm currently working on a Utilization Management RN opportunity with a health plan client, supporting a... ...remote in EST hours. This position will be reviewing prior authorization requests, assessing medical necessity and benefit coverage...Remote workContract workTemporary workMonday to FridayShift work
- 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...Remote jobFull time
$39 - $40 per hour
...Healthcare Recruiter at The Judge Group Utilization Management Registered Nurse (RN) Type: 6-Month Contract W2 Location: Remote - but MUST reside in one of the... ...Management RN experience, including Prior Authorization and Concurrent Review Experience...Remote workDaily paidContract workMonday to FridayShift workWeekend work- Centene is seeking an experienced Supervisor of Utilization Management to lead the Prior Authorization, Concurrent Review, and Retrospective Review teams. This remote role supports members across the health plan with a focus on quality and compliance. You will supervise...Remote job
- ...Community) Is a Non-profit Managed Care Organization (MCO),... ...Summary Behavioral Health Utilization Manager will perform concurrent... ...facility contract status prior to processing authorization requests. Complies with... ...telephone systems Work Schedule: Remote Other Requirements Able to...Remote workContract workWork experience placement
- ...Utilization Management Registered Nurse (UM RN) We're seeking a dedicated and detail-oriented Utilization Management... .../NCD policies). This is a fully remote opportunity requiring discipline... ..., MCG). Evaluate and process prior authorization (PA) requests in a timely,...Remote work
- ...is seeking an experienced Registered Nurse for a fully remote Utilization Management Nurse Consultant role. This position is ideal for individuals... ...schedule of Mon-Fri, 8:00 AM-5:00 PM with potential on-call coverage. Prior authorization experience is valued. #J-18808-LjbffrRemote work
- ...seeking a Nurse Consultant for Utilization Management in a 100% remote role. You will apply... ...collaborate with providers to authorize care, and elevate cases... ...position requires active RN licensure, 3+ years of acute... ...in concurrent review or prior authorization, with a mandatory...Remote work
$32.01 - $68.55 per hour
## Utilization Management Nurse ConsultantApply: Remote: IL - Work from home: Work At Home-Ohio: Work At Home-Texas:... ...care RNActive and unrestricted RN licensure in state of residenceAble... ...) **Preferred Qualifications**Prior authorization utilization experience preferredOutpatient...Remote workHourly payFull timeTemporary workWork at officeWork from homeMonday to FridayAfternoon shift$29.1 - $62.32 per hour
...Utilization Management Nurse Consultant Clinical Precertification RN (Medicare) Remote | Full-Time | Weekday Schedule Are you a Registered Nurse ready to make an impact... ...to Have Utilization Management or Prior Authorization experience Managed care background...Remote workHourly payFull timeTemporary workWork at officeWork from homeMonday to FridayAfternoon shiftWeekday work- ...Corporation is seeking an experienced Utilization Management Nurse Consultant for the Spine Team, working remotely. You will review spine-related prior authorizations, apply MCG guidelines, assess... ...decisions. The role requires an active RN license, 3-5+ years of clinical...Remote job
$29.1 - $62.32 per hour
...accredited medical management organization... ...Summary Join our Utilization Management team as... ...collaborate with providers, authorize care, and escalate... ...providers. Remote Work Expectations... ...review or prior authorization preferably... ...degree in nursing (RN) required, BSN...Remote workHourly payFull timeTemporary workWork experience placementLocal areaMonday to FridayFlexible hoursShift workWeekend work$45 per hour
...Description Job Description Utilization Management Nurse Coordinator (RN or LVN) needed for a temp 6+ month, remote contract opportunity with... ...reviews outpatient authorization requests, assesses medical... ...in Utilization Management, Prior Authorization, Case Management...Remote workContract workTemporary workMonday to FridayWeekend work$29.1 - $62.32 per hour
...family and one community at a time. Utilization Management Nurse Consultant Clinical Precertification RN (Medicare Home Care) Remote | Full-Time | Weekday Schedule Are you... ...Qualifications Utilization Management or Prior Authorization experience Managed care background...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeMonday to FridayAfternoon shiftWeekday work$29.1 - $62.32 per hour
## Utilization Management Nurse Consultant - Behavioral Health (Remote)Apply: Remote/Hybrid: AZ - Work from home... ...collaborate with providers, authorize care, and escalate... ...concurrent review or prior authorization... ...'s degree in nursing (RN) required, BSN preferred...Remote jobHourly payFull timeTemporary workWork experience placementWork from homeMonday to FridayFlexible hoursShift workWeekend work$45 - $51 per hour
...Position Details Position: RN Utilization Management / Utilization Review Setting: 100% Remote Schedule: 5x8-hour days Hours: 8... ...utilization of healthcare resources. Manage prior authorization and pre-certification activities when applicable...Remote workHourly payFull timeWeekend work$26.01 - $62.32 per hour
...one family and one community at a time. Utilization Management Nurse Consultant Clinical Precertification RN (Medicare) Remote | Full-Time | Weekday Schedule Are... ...Nice to Have · Utilization Management or Prior Authorization experience · Managed care background...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeMonday to FridayAfternoon shiftWeekday work$26.01 - $62.32 per hour
...one family and one community at a time. RN Utilization Management Nurse Consultant (Medicare – Joint Procedures) Remote | Full-Time | Monday–Friday (9:00 am to 5:... ...Nice to Have Utilization Management or Prior Authorization experience Managed care and/or Medicare...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeMonday to FridayAfternoon shiftWeekday work$32.01 - $68.55 per hour
...and every day. Position Summary This Utilization Manager position is with Aetna's Long-Term... ...Supports (LTSS) team and is a fully remote role. Candidates must hold a New York... ...Term Care experience Experience with Prior Authorizations Knowledge of Medicaid and Medicare processes...Remote workHourly payFull timeLocal area10 hours per weekFlexible hours$28 per hour
LPN Utilization Management Nurse Reviewer Miami, FL (Work from Home position... ...the plan of care Provide authorizations and notifications in a timely... ...for DME: 1 year (Required) prior authorization UM review: 1... ...(Required) Work Location: Remote #J-18808-Ljbffr Coastal Care...Remote workHourly payFull timeWork at officeLocal areaWork from homeRelocationHome officeWeekday work$95k - $107.5k
...Title: Nurse Reviewer Utilization Management Job Type: Full-... ...Brighton MA office; 1 day remote FLSA Status:... ...coverage requirements to authorization requests coordinates... ...coverage policy. Review prior authorization and... ...in Nursing (ADN/RN) required; Bachelors...Remote workFull timeLocal area- ...Description Job Description: Manager of Clinical Utilization Management - Denial... ...Position Type: Hybrid (85% remote, 15% onsite in Northridge,... ...Registered Nursing Program; RN preferred. 2. Minimum of five years in prior-authorization, appeals & grievance, or health...Remote workPermanent employmentFull timeTemporary workFlexible 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
- ...Job Title: Utilization Management Registered Nurse (UM RN) – SNF / MLTC Location: Remote (Must reside in NY, NJ, or CT) Schedule:... ...care organizations regarding authorizations, medical necessity reviews,... ...utilization management platforms. Prior experience handling appeals,...Remote workFull timeMonday to Friday
$1,949.74 per month
...Specialty Utilization Review Job ID... ...Utilization Review RN Weekly Pay... ...Job Description Remote Utilization Review RN... ...necessity determinations, prior authorizations, continued stay reviews, and utilization management using InterQual criteria...Remote workWeekly payShift work- ...Cleveland Clinic is seeking an Utilization Management RN Reviewer to support remote operations from home. The role covers admission and concurrent reviews, and ensures medical necessity criteria are applied to hospital stays and discharges. Qualifications include RN...Remote work
- ...Plan in the United States is seeking an Inpatient Utilization Management Clinician to evaluate inpatient medical necessity,... ...discharge planning across care teams. This fully remote, full-time role requires an active RN license, nursing degree, and experience with InterQual...Remote workFull time
- ...Utilization Management RN (Part-Time, Remote) Position Overview Under the direction of a designated manager, the Utilization Management RN... ...clinical experience in a hospital or healthcare setting Prior discharge planning and/or utilization management...Remote workPart timeMonday to Friday
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