Remote RN: Prior Authorization & Medical Necessity Review
Spectraforce Technologies, Inc.
Houston, TX
- Remote job
Spectraforce Technologies, Inc. is seeking a Clinical Review Nurse - Prior Authorization for a 12-month assignment. The role is remote (PST/CST) with scheduling across multiple shifts, supporting national guidelines and contractual requirements. You will review PA requests for medical necessity, assess complex cases, and guide the medical team to ensure appropriate care while aligning with compliance standards. RN licensure is required, with preferred NV/Compact credentials. #J-18808-Ljbffr Spectraforce Technologies, Inc.
Vacancy posted 5 days ago
Similar jobs that could be interesting for youBased on the Remote RN: Prior Authorization & Medical Necessity Review in Houston, TX vacancy
$1,949.74 per month
...Specialty Utilization Review Job ID 179796... ...Utilization Review RN Weekly Pay $1... ...Job Description Remote Utilization Review RN responsible... ...for concurrent reviews, medical necessity determinations, prior authorizations, continued stay reviews,...Remote workMedicalWeekly payShift workProvidence Health and Services
Eureka, CA6 hours ago- ...DescriptionJob DescriptionLocation: Fully remote. Candidates must be able to work... ...an experienced Concurrent Review Registered Nurse (RN) to join its Utilization... ...will perform concurrent reviews, prior authorizations, medical necessity reviews, discharge planning, and...Remote workMedicalWork at officeImmediate start
Impresiv Health
Henderson, NV2 days ago - ...hiring a Registered Nurse for a remote US contract role. You will review Medicaid prior authorization requests, apply InterQual criteria, and determine medical necessity while maintaining high productivity... ...position requires 3+ years of RN experience, compact license, and...Remote jobMedicalContract work
$53 per hour
Phaxis - Healthcare is hiring for a REMOTE RN opportunity focused on Grievance & Appeals and Utilization Review. The role requires candidates to reside... ...background, and experience with prior authorizations and medical necessity reviews. #J-18808-Ljbffr Phaxis - HealthcareRemote jobMedicalLong term contractContract workMonday to Friday- ...Health Partners is seeking a Virtual Utilization Review Specialist to join our remote team. You will perform medical necessity reviews, manage denials, and coordinate with... ...controlling costs. Qualified candidates hold a current RN license, have at least 1 year in denials...Remote jobMedical
- NTT DATA, Inc. is seeking a Clinical Reviewer Specialist for a fully remote position based in Florida. You will perform clinical and medical necessity reviews for member and provider appeals... ...and NCQA compliance. The role requires RN licensure (Florida or compact), 3+...Remote jobMedical
$35 - $40 per hour
...analytics. Job Title RN Utilization Management Reviewer Responsibilities... ...requiring prior authorization in a variety of clinical... ..., Medicare Part B medications, LTSS, and Home Health... ...determine medical necessity. Communicate... .... Location: Fully remote work at home role....Remote workMedicalHourly payTemporary workMonday to FridayFlexible hoursWeekend workSagility LLC
New York, NY1 day ago- ...Corporation is seeking an Authorization Management Clinical Reviewer - Appeals and Denials to join our remote team. You will review acute... ...acute requests to determine medical necessity using InterQual guidelines... ...The role requires an active RN license, 4-6 years of relevant...Remote jobMedical
- ...is seeking an Appeals Nurse to review medical records and claims information for... ...cases, determining medical necessity and compliance with CMS guidelines. The RN collaborates with Appeals Examiners... ...ensure timely redeterminations. This remote role is eligible in several...Remote jobMedical
$35 - $40 per hour
...healthcare transformation, seeks an RN Utilization Management Reviewer for a fully remote role. You will perform timely... ...for services requiring prior authorization across various clinical areas... ...judgment to determine medical necessity. Hours are Mon-Fri 9:00 AM-5:...Remote jobMedicalHourly pay$64.48k - $72.8k
...Overview: The Clinical Review & Correspondence RN plays a critical role in... ...by conducting medical necessity reviews, preparing clear... ...role: This is a 100% remote role, and requires robust... ...continuum–including policy, prior authorization, payment accuracy, and more...Remote workMedicalFull timeFlexible hoursShift work$68.64k - $72.8k
...Opportunity Overview: The RN Reviewer position is a crucial... ...prospective review (prior authorization) admission,... ...protocols to determine the medical appropriateness of... ...to assess the medical necessity of inpatient... ...collaboration skills across remote teams Customer-focused...Remote workMedicalHourly payFull timeFlexible hoursShift workWeekend work- ...Technologies, Inc. is seeking a Clinical Review Nurse - Prior Authorization for remote work with PST/CST alignment. The... ...requests to confirm medical necessity and appropriate care levels per standards... .... The ideal candidate has an RN license with 2–4 years of PA...Remote workMedical
Spectraforce Technologies
United States2 days ago $45 - $51 per hour
...Details Setting: 100% Remote Hours: 8:00 AM 4:30 PM... ...Position Details Position: RN Utilization Management / Utilization Review Setting: 100% Remote... ...determining medical necessity and appropriate level... ...healthcare resources. Manage prior authorization and pre-certification...Remote workMedicalHourly payWeekend workHanker Systems, Inc.
New York, NY1 day ago- ...Management Location: 100% Remote Schedule: M-F 9:00am to 5... ...have an Illinois state RN license Assess and analyze... ...and eligibility Process prior authorization determinations within regulatory... ...for inpatient medical necessity/utilization review and other utilization management...Remote workMedicalContract work
Integrated Resources
Springfield, IL6 hours ago - ...Overview Title: Clinical Review Nurse – Prior Authorization Review Location: Fully Remote (PST Time Zone - WA/... ...and collaborate with medical directors, providers,... ...Performs medical necessity and clinical reviews of... ...Qualifications ~ Active RN license (WA; must be...Remote workMedicalContract work
SPECTRAFORCE
Washington DC6 hours ago - ...Capgemini, is seeking a Clinical Review Nurse for a fully remote, full-time role. You will... ...and policies to decide medical necessity. Successful candidates... .... The role requires an RN or LPN license, at least two years of prior authorization review experience, and strong...Remote workMedicalFull time
HealthHelp
United States6 hours ago $34 - $47 per hour
...UM Review NurseAstrana Health is looking... ...deny outpatient medical services for patients... ...based on Medical Necessity Criteria,... ...Plans. This is a remote position for CA-licensed... ...'ll Do:Complete prior authorization/retrospective review... ...LVN or RN license in California...Remote workMedicalHourly payLive inWork at officeMonday to FridayShift workCredenza Health
Monterey Park, CA1 day ago$35 - $45 per hour
...IntePros IntePros is seeking a Remote Utilization Review Nurse serves as a key... ...Process patient prior authorization and reauthorization requests... ...Milliman Care Guidelines, and medical necessity requirements. Provide... ...professional nursing program (RN, LPN, or LVN). Minimum of...Remote workMedicalContract workWeekend workIntePros
New York, NY1 day ago- WPS Health Solutions seeks an Appeals Nurse (RN) to review medical records for first-level appeal cases and determine medical necessity under Medicare guidelines. The role... ...and clinical experience are required, with remote work options available in designated states...Remote jobMedical
- ...Position Title: Clinical Review Nurse - Prior Authorization Work Location: Remote - PST and CST-(No CA and NY candidates... ...) / Preferred: NV or Compact RN license Assignment Duration:... ...authorization requests to determine medical necessity of service and appropriate...Remote workMedicalFlexible hoursShift workWeekend work
Spectraforce Technologies
Las Vegas, NV2 days ago - ...seeking an Appeals Nurse to review medical records and claims for first-... ...appeals to determine medical necessity under Medicare guidelines. The... ...reviewed and completed. A valid RN license and 1+ year clinical... ...are required, with remote work options available in approved...Remote jobMedical
- ...Description Utilization Review Nurse Location: [City, State / Remote] Employment Type:... ...to evaluate the medical necessity, appropriateness,... ...Registered Nurse (RN) with experience... ...payers regarding authorization and coverage determinations... ...methodologies and prior authorization...Remote workMedicalFull timeSecond jobWork at office
Ova Technologies
Alpharetta, GA2 days ago $34 - $40 per hour
...0/hr - $40.00/hr Remote (Compact Licensure... ...Open to LPN's & RN's About the Role... ...experienced Utilization Review Nurse to support... ...review patient authorizations, ensure... ...You’ll Do Process prior authorization and... ...documentation to determine medical necessity for continued...Remote workMedicalFull timeMedix
New York, NY1 day ago- HealthHelp, a WNS company, seeks a Clinical Review Nurse for a fully remote role in the United States. You will perform prospective reviews for medical necessity on prior authorization requests across multiple specialty programs and refer non-qualifying cases to Physician...Remote jobMedical
$35 - $40 per hour
...Registered Nurse (RN) with health plan or... ...support clinical quality review and AI model development for prior authorization use cases. The... ...and MCG, reviewing medical records, evaluating medical necessity, and auditing... ..., 40 hrs/weekFully Remote PositionPay Range:...Remote workMedicalLocal areaShift workPRIDE Health
Minneapolis, MN1 day ago- ...Utilization Review NurseThis position has a remote option for those living close and... ...Leader of Leaders.The prior authorization role completes an assessment... ...service and if it is medically necessary.Promote... ...requested services for medical necessity based upon evidence-...Remote workMedicalFull time
CHRISTUS Health
Alamogordo, NM3 days ago - ...Position Title Clinical Review Nurse - Prior Authorization Work Location Remote; nationally sourced within approved U.S. states. Must be available... ...submitted clinical documentation, determining medical necessity within scope, requesting additional information...Remote workMedicalWork at officeMonday to Friday
Spectraforce Technologies
Jacksonville, FL2 days ago $50 - $55 per hour
...Remote Utilization Review RN | CA RN License Required - -Must sit in CA We're seeking an experienced... ...with Post-Service Review, Prior Authorization, and/or Concurrent Review Knowledge... ...and clinical documentation Strong medical necessity/clinical review skills Excellent...Remote workMedicalContract workTemporary workActalent
New York, NY1 day ago- ...for clinical member services review assessment processes.... ...verifying that services are medically necessary and align with established... ...reviews to determine prior authorization/financial responsibility for... ...experience. Registered Nurse (RN). License must be active and...Remote jobMedicalWork at office
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote RN: Prior Authorization & Medical Necessity Review. Be the first to apply!
Related searches