Remote Clinical Review Nurse - Prior Authorization
Centene Corporation
Centene Corporation seeks an LPN/RN with medical necessity review experience to assess prior authorization requests and determine appropriate level of care. This full-time role offers remote work from anywhere in the United States and standard M–F hours with occasional weekend coverage in a local time zone. You will collaborate with medical directors, providers, and internal teams to promote timely, cost effective care, document clinical information, and ensure compliance with Medicare/Medicaid #J-18808-Ljbffr
- ...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...Remote workContract work
- ...Purpose: Analyzes all prior authorization requests to determine... ...Accredited School of Nursing or Bachelor's degree... ...experience. Clinical knowledge and ability... ...and clinical reviews of authorization requests... ...supportive; Team is REMOTE but team relies heavily...Remote 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
$2,300 per month
...The Clinical Review Nurse (RN) supports the organization’s care management function by conducting... ...outcomes for members. This is a remote role open to candidates residing in... ...processing of pre-certification, prior authorization, and concurrent review requests....Remote workPart timeWork at office- ...Clinical Review Nurse - RemoteARC Group has multiple positions open for Clinical... ...! These positions are 100% remote. These are direct hire FTE... ...have PERMANENT US work authorization.Summary Statement: The Clinical... ...include cases requiring prior authorization, complex pre-...Remote workPermanent employmentWork at officeLocal area
$35 - $40 per hour
...Job Title: Clinical Prior Authorization Reviewer Job Description This role focuses on reviewing prior authorization requests to determine medical... ...or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is...Remote workContract workTemporary workShift work$27.02 - $48.55 per hour
Position Purpose Analyzes all prior authorization requests to determine... ...have the flexibility to work remotely from their home anywhere within... .... This team performs clinical reviews for medical and behavioral... ...from an Accredited School of Nursing or Bachelor's degree in Nursing...Remote workHourly payFull timePart timeWork at officeWork from homeMonday to FridayFlexible hours- 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
$35 - $40 per hour
...Clinical Prior Authorization Reviewer This role focuses on reviewing prior authorization requests to determine the medical necessity of services and... ...or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated...Remote jobContract workTemporary workWork at officeShift work- ...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
- ...Virginia, (or) DC states \n \n Role: HEDIS Clinical Review Nurse \n W2 Contract: 5 Months \n Location: Primarily remote \n \n ~ Requires mandatory on-site... ...\n \n Preferred Qualifications: \n • Prior experience performing HEDIS overreads and high...Remote workContract workWork at officeLocal area
- ...5 months Work Location: Primarily Remote (Hybrid focus for candidates residing... ...leading healthcare organization as a Clinical Medical Review Nurse supporting the annual HEDIS retrospective... ...). Preferred Qualifications: Prior experience performing HEDIS overreads...Remote workContract workWork at officeLocal area
$40 - $43 per hour
...Job Description Job Description Title: Clinical Review Nurse – Medicaid Denial Letters Location: Fully Remote – Florida Pay: $40.00–$43.00 per hour, based... ...supporting Medicaid health plan operations. Prior experience working in a remote healthcare position...Remote workHourly payFlexible hoursShift work- ...Summary: Work Mode: 100% Remote - MS (candidates can be... ...medical necessity reviews of inpatient admissions and... ...continued stays. Apply clinical criteria and guidelines such... ...clinical documentation. Make authorization determinations within nursing scope. Identify...Remote workHourly payFlexible hoursShift workWeekend work
- ...Position Title Clinical Review Nurse - Concurrent Review Work Location Remote (EST preferred but will consider CST) Assignment Duration 6 months Work Schedule Eastern 8-5 with expected weekend and holiday coverage based off the team needs. This is usually...Remote workWeekend work
$71.1k - $97.8k
...Skills Research Institute is seeking a Pre-Authorization Registered Nurse to join their team. This role involves reviewing prior authorization requests to ensure appropriate... ...licensed RNs with a minimum of two years clinical experience. The compensation ranges from $7...Remote jobWork from home- ...Medical Record Retrievers/Clinical Record Reviewers to support a need for... ...Location: Primarily remote. Candidates are... ...state, OR Certified Nursing Assistant (CNA) or Medical... ...Nice to have: Prior experience with Epic... ...recruiting activities and all Authorized GeBBS Consulting...Remote 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- ...Centene Corporation is seeking a remote Utilization Review Nurse to perform concurrent reviews and validation of appropriate care levels. You will assess inpatient services, discharge planning, and coordination with Medical Affairs across Medicaid and Marketplace programs...Remote work
- ...About This Role The Clinical Review Nurse-Concurrent Review performs concurrent reviews to determine members' overall health and the appropriateness... ...of utilization management processes. Highlights Location: Remote, OK Schedule: Full Time, Monday-Friday 8am - 5pm, rotational...Remote workFull timeWork at officeMonday to FridayFlexible hoursWeekend work
- ...Spectraforce Technologies, Inc. is seeking a Clinical Review Nurse for remote concurrent review responsibilities. The role assesses member health status, medical necessity, and appropriate care levels, contributing to discharge planning within care policies and guidelines...Remote work
- ...Blueprints Enterprise Architecture EnterpriseTransformation. Position: Clinical Medical Review Nurse HEDIS Retrospective Project Locations: Columbia MD Work Arrangement: Primarily Remote Occasional Provider-Site Visits Position Overview We are seeking experienced...Remote workContract work
- ...Spectrumforce Technologies, Inc. is seeking a Clinical Review Nurse - Concurrent Review for a 3-month contract to hire. The role is remote with work location listed as Remote-MS CST, schedule 8 am-5 pm Central time, with occasional weekend rotation. You will perform...Remote workContract work
$27.02 - $48.55 per hour
...Concurrent Review Nurse Position Purpose: Performs concurrent reviews, including determining... ...Key Details: This position is fully remote/work from home, and will support Medicaid... ...of care and medically necessity based on clinical policies and guidelines Reviews member...Remote workHourly payFull timePart timeWork at officeMonday to FridayFlexible hours$27.02 - $48.55 per hour
...Centene is seeking a Clinical Review Nurse to perform concurrent reviews to assess members' health, determine medical necessity, and contribute... ...strong utilization management knowledge. You will work remotely in North Carolina, with a full-time day shift and pay...Remote workHourly payFull timeDay shift- ...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
$26.01 - $68.55 per hour
...About This Role The Clinical Claims Review Nurse at CVS Health is responsible for reviewing and interpreting clinical documentation, applying... .... Highlights Pay: $26.01 - $68.55/hour Location: Remote, ND Schedule: Full-time What You'll Do Review and...Remote workFull time- ...Centene Corporation is seeking a Nurse Reviewer for remote work in the United States. The role involves performing concurrent reviews to determine appropriate level of care and discharge planning, with emphasis on medical necessity and care setting. Requires active...Remote work
- ...Clinical Medical Review Nurse Ampcus Inc. is a certified global provider of a broad range of Technology and Business consulting services. We are... ...team with professionalism and a collaborative mindset. Remote work environment with minimal physical demands. Ampcus...Remote work
- ...Clinical Medical Review Nurse We are seeking Licensed Practical Nurses (LPN) or Registered Nurses (RN) to join the Quality team as Clinical Medical... ...Nurses. This is a hybrid contract position requiring both remote work and regular onsite presence at the Canton, MD office....Remote workContract workWork at office
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