Remote Clinical Review Nurse — Prior Authorization
Centene Corporation
- Remote job
Centene is seeking a Clinical Review Nurse - Prior Authorization for a remote Texas role. The incumbent will analyze medical necessity of authorization requests and determine appropriate levels of care in line with regulatory guidelines and contract terms. Collaboration with providers and the authorization team is essential to ensure timely service and compliant care delivery. The role requires an RN license in Texas and nursing education with 2–4 years of related experience, with knowledge of #J-18808-Ljbffr Centene Corp.
- ...Spectraforce Technologies, Inc. is seeking a Clinical Review Nurse - Prior Authorization for remote work with PST/CST alignment. The role evaluates pre-authorization requests to confirm medical necessity and appropriate care levels per standards and payer coverage....Remote work
- ...WNS, part of Capgemini, is seeking a Clinical Review Nurse for a fully remote, full-time role. You will perform prospective utilization reviews... ...requires an RN or LPN license, at least two years of prior authorization review experience, and strong documentation skills....Remote workFull time
- ...Position Title Clinical Review Nurse - Prior Authorization Work Location Remote - PST and CST (No CA and NY candidates please) Assignment Duration 12 Months Work Schedule Sunday - Thursday 7am - 4pm 8am - 5pm 9am - 6pm 10pm - 7pm Shifts depend on what the team needs....Remote workFlexible hoursShift work
- ...Position Title Clinical Review Nurse - Prior Authorization Work Location Remote; nationally sourced within approved U.S. states. Must be available during standard business hours for the assigned team. Assignment Duration 12 Months possibility of extension...Remote workWork at officeMonday to Friday
- ...DescriptionJob DescriptionCLINICAL REVIEW NURSE - REMOTE ARC Group has multiple positions open for Clinical Review Nurses! These... ...currently have PERMANENT US work authorization. Sorry, but we are not... ...may include cases requiring prior authorization, complex pre-payment...Remote workPermanent employmentWork at officeLocal area
- ...Job Title: Clinical Review Nurse - Prior Authorization - J00927 Address: Various, NJ Job Description: Conduct clinical reviews and authorize prior approvals... ...of all review activities. Critical Information: Remote work possible Shift/hours: Standard business hours, flexibility...Remote workFull timeShift work
$27.02 - $48.55 per hour
...Position Purpose: Analyzes all prior authorization requests to determine... ...Key Details: This fully remote role requires an active New... ...medical necessity and clinical reviews of authorization requests to... ...Experience: Bachelor’s degree in Nursing (BSN) or graduation from an...Remote workHourly payFull timePart timeWork at officeMonday to FridayFlexible hours- A healthcare staffing company is seeking a Clinical Review Nurse for Prior Authorization Review. This remote role demands conducting reviews, collaborating with healthcare teams, and ensuring compliance. Candidates need an active RN license and 2-4 years experience in Prior...Remote jobContract work
- Centene Corp. is seeking a remote RN to perform prior authorization reviews in New York. You will assess medical necessity, collaborate with providers and the authorization team, and help ensure timely, appropriate care for members. The role requires a NY RN license and...Remote jobWeekday work
- Spectraforce Technologies, Inc. is seeking a Clinical Review Nurse - Prior Authorization to perform clinical reviews of authorization requests using established... ...decisions, and meeting turnaround times. This is a remote role with a 12-month duration and potential extension....Remote job
- WNS Global Services, a HealthHelp partner, is recruiting a Clinical Review Nurse for a fully remote, full-time role in the United States. You will perform prospective utilization reviews of prior authorization requests against medical necessity criteria, uphold productivity...Remote jobFull time
$65k - $75k
...Nurse - Clinical ReviewThe Clinical Review Nurse makes prospective medical necessity determinations on prior authorization requests for HealthHelp's specialty programs, including Diagnostic Imaging... ....This is a full-time, fully remote, production-based role. Reviewers work...Remote workHourly payFull timeWork at officeLocal areaMonday to Friday- ...A healthcare organization is seeking a Clinical Review Nurse – Concurrent Review to perform utilization management functions remotely. The role requires conducting concurrent reviews, collaborating with medical teams, and ensuring quality healthcare outcomes. Candidates...Remote workWork at office
- ...Job Description: Clinical Supervisor, UM Denial... ...Position Type: Hybrid (85% remote, 15% onsite in... ...daily tasks, performance reviews, and disciplinary actions... ...Registered Nursing Program; RN preferred... ...Minimum of five years in prior-authorization, appeals & grievance,...Remote workPermanent employmentTemporary work
- ...To support the Home Health Services Team, the full-time Clinical Review Nurse will manage clinical staff oversight, ensure accurate documentation... ..., and implement educational initiatives, all while working remotely during day shifts. Key responsibilities Direct clinical...Remote workFull timeDay shift
$27.02 - $48.55 per hour
...Purpose: Performs concurrent reviews, including determining member... ...Details: This role is fully remote/work from home. The role will... ...or LTC experience. RN compact nursing licensure is preferred or be... ...medically necessity based on clinical policies and guidelines Reviews...Remote workHourly payFull timePart timeWork at officeWork from homeMonday to FridayFlexible hoursWeekend work$36.49 - $41.49 per hour
Pay Range: $36.49hr - $41.49hr Job Overview: The Clinical Medical Review Nurse handles the day-to-day review of professional and institutional claims... ...excellent verbal and written communication skills. Remote EMR access is essential, as well as ambulatory practice experience...Remote workTemporary workWork at officeLocal area- ...Job Title: Clinical Review Nurse - Concurrent Review - J00933 Address: Various, SC Job Description Perform concurrent reviews to assess... ...Information Schedule: Monday-Friday, 8:00 AM-5:00 PM EST Remote: 100% Remote Hours: Full-time, 40 hours per week Weekend...Remote workFull timeMonday to FridayWeekend work
- ...Work Mode: 100% Remote, Source candidates from EST preferred but... ...Responsibilities: Perform concurrent reviews of members for appropriate... ...medical necessity based on clinical policies and guidelines.... ...from an Accredited School of Nursing or Bachelor’s degree in Nursing...Remote workWeekend work
- ...Title: Clinical Review Nurse- Concurrent Reviews Location: Remote- KY or Compact state license Duration: 6 months with possible extension or conversion Schedule: Tues- Sat 8-5pm EST This is an every Saturday position and manager is open to 4-10...Remote workShift work
- ...Position Title: Clinical Review Nurse - Concurrent Review Work Location: Remote, Compact Nursing License Required, Central Time Zone Work Schedule Assignment Duration: 12-Month Contract to Hire Work Schedule: Mon-Friday, 11 AM to 8 PM CST; Weekends and Holidays...Remote workContract 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- ...Position Title Clinical Review Nurse - Concurrent Review Work Location Remote-MS CST Assignment Duration 3 Months Contract to Hire Work Schedule 8 am-5 pm (Central). OT is voluntary; weekend rotation once every 2 months Work Arrangement Remote...Remote workContract workFlexible hoursWeekend work
- ...motivated candidate to join our talented Team. Job Title: Clinical Medical Review Nurse. Location: Owings Mills, MD. Summary The Contingent RN supports... ...team with professionalism and a collaborative mindset. Remote work environment with minimal physical demands. Ampcus is...Remote work
$60.53k - $129.63k
...bigger – helping to simplify health care one person, one family and one community at a time. Position Summary: As a Clinical Claim Review Nurse, you will leverage your clinical expertise to review medical records and post-service claims, apply established clinical...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from home- ...our team! As a Utilization Review Nurse, you will utilize your critical thinking skills, clinical expertise and judgement along... ...require medical necessity authorization. We are seeking individuals who... ...is preferred. In addition to prior experience, the ideal candidate...Remote workLocal area
- Spectraforce Technologies, Inc. is seeking a Clinical Review Nurse for concurrent reviews related to KY Medicaid inpatient stays. The position... ...Marketplace and Medicaid lines with a small, busy team in a remote-capable setup requiring KY or compact state licensure. Role...Remote jobShift work
- Accede Solutions Inc. is hiring a Remote Clinical Review Nurse (Concurrent Review) for a 12-month contract. The role focuses on NCQA-aligned clinical reviews and drafting correspondence letters related to denial determinations for Medicaid products in IL and MI. You will...Remote jobContract workLocal area
- Centene Management Company LLC is seeking a remote RN reviewer to perform concurrent reviews, determine appropriate level of care, and support discharge planning for members. Strong preference for an active NY RN license; typical hours are Mon-Fri 8:30 AM-5:00 PM ET, with...Remote job
- SCAN is seeking a California-licensed registered nurse to provide clinical review of medical claims and post-service appeals. You will ensure medical... ...the Medical Director on denials and appeals. This is a remote position with competitive pay and benefits. #J-18808-Ljbffr...Remote job
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