Remote UM Specialist II: Clinical Review & Authorization
Trillium-Health-Resources
- Remote job
Trillium Health Resources is seeking a dedicated Utilization Management Specialist II to support clinical review by validating service authorization requests and coordinating workflow from intake to determination. You will verify documentation, route cases to clinical staff, monitor timelines, and track determinations to ensure timely and accurate decisions. Remote within North Carolina with standard hours and occasional travel as needed. #J-18808-Ljbffr Trillium-Health-Resources
- ...Work Mode: 100% Remote, Candidates with Central... ...Analyze all prior authorization requests to determine... ...care. Consolidate clinical information into an easy... ...Conduct medical necessity reviews with clinical information... ...Not an RN, no PA and UM experience...Remote workShift work
- ...PRN Physician Coding Specialist II, Orthopedic Clinic - Sheffield Village Under the direction of the Revenue... ...meeting departmental guidelines. Reviews and corrects coding edits and denials... ...Level: Entry Level Travel: No Remote Work: Hybrid Job Posting: Jul 10,...Remote workDaily paidWork experience placementRelief
$62.7k - $100.4k
...Job Summary: Clinical Care Reviewer II is responsible for processing medical necessity reviews for appropriateness of authorization for health care services, assisting with discharge planning activities (i.e. DME, home health services) and care coordination for members...Remote workHourly payWork at office- ...Alliance Health is seeking a UM Clinical Specialist-LTSS for full-time remote work, NC-based. You will perform utilization reviews and authorizations for I/DD and TBI waivers, ensuring services meet clinical guidelines and are provided in the least restrictive setting...Remote workFull time
- ...To support timely access to mental healthcare, the full-time remote Authorization Specialist II will manage authorization data accuracy, process incoming authorization packets, and resolve client-related issues while collaborating closely with Billing and Eligibility...Remote workFull time
$56.27k - $69.9k
...application process. Professionals Remote, Remote, US 2 Attachments 5... ...opening for a Utilization Management Specialist II to join our team! The... ...Management Specialist II supports clinical review by validating service authorization requests and managing workflow from...Remote workWork at officeImmediate startWork from homeFlexible hours$64k - $78k
...is seeking an RN for a position focused on prior authorizations in Tacoma, WA. This role involves reviewing authorization requests, collaborating with care teams... ...will possess an RN license and 2-5 years of clinical experience. The position offers a competitive salary...- ...Carolina is hiring a Utilization Management Specialist II to validate service authorization requests and manage workflow from... ...ensure completeness, route cases to clinical staff, and monitor timelines to support timely, accurate reviews. Typical day includes verifying...Remote job
- Grow Therapy in the United States is seeking an Authorization Specialist II to ensure timely access to care by keeping authorization data accurate... ...while partnering with Billing and Eligibility. This fully remote hourly role offers benefits such as comprehensive health...Remote jobHourly pay
$18.99 per hour
...professional looking for an impactful remote role? We are seeking dedicated Authorization Specialists to join a fast-paced,... ...be responsible for receiving, reviewing, validating, and creating prior... ..., and collaborate closely with clinical review teams, provider relations...Remote workHourly payPermanent employmentTemporary workWork experience placementWork at officeWork from homeMonday to FridayShift work$71k - $85k
Starling Oncology is seeking a UM Authorization Analyst II to ensure timely, accurate processing of medical procedure authorizations and maintain... ..., and professional growth. This position can be worked remotely from anywhere in the contiguous United States, on an Eastern...Remote job- Medix is seeking a Clinical Review RN for Prior Authorization, with 2 years of acute care experience and 1 year in prior authorization. The role supports... ...and analysts to ensure accurate authorizations. Onsite in Jericho or remote in RI is possible. #J-18808-Ljbffr Medix™Remote job
- ...Pharmacy Prior Authorization Specialist Provide technical and administrative... ...the client teams, Clinical Program Managers (... ...Information and PA&UM staffs with the... ...programs. Manage review/QA process for medical... ...location (or from a remote location with management...Remote workFull timeLocal areaMonday to FridayNight shiftWeekend 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 jobHourly payWork from homeFlexible hours- ...Position Title: Clinical Review Nurse - Prior Authorization Assignment Duration: 6 months; potential to extend/convert Work Schedule: OT as needed... ...- Fri / Possible holiday shifts Work Arrangement: Remote-Central Time Zone preferred Responsibilities:...Remote workShift work
- Virtix Health is seeking a remote Clinical Reviewer (RN) to support the WISeR Prior Authorization program. You will perform clinical reviews, validate documentation, and support physician determinations in CMS-compliant workflows. This 24/7 operation requires strong analytical...Remote job
$69.3k - $78k
Overview Medical Review Nurse II - Clinical Validation At Performant, we’re focused on helping our clients achieve their goals by providing technology... ...for Government and Commercial Payers. You will work remotely in a fast paced and dynamic environment and be part of a...Remote workFor contractorsWork at officeWork from homeHome officeShift work$69.3k - $78k
...healthcare payment integrity company is seeking a Medical Review Nurse II - Clinical Validation to perform medical claims audits for Government... ...include auditing claims and documenting findings, all in a remote work environment. This role offers a competitive salary range...Remote job- Centene Corporation is seeking a clinical professional on our Medical Management/Health Services team to review prior authorization requests and determine medical necessity for NY members... ...and cost-effective care, with flexible remote/hybrid/work options. #J-18808-Ljbffr...Remote jobFlexible hours
$44 per hour
...Clinical Review Nurse - Prior Authorization Various, NV Clinical Review Nurse - Prior Authorization Various, NV All On-site Location: Fully Remote – Prefer Candidates reside in NV, but can reside elsewhere if they have an NV RN License. SHIFT: Training...Remote workPermanent employmentContract workLive inShift work$19.8 - $31.25 per hour
Prior Authorization Specialist II Pharmacy Services CFHP Community First Health Plans TPA DCHP PHM POPULATION... ...prior authorization requests for review by nurse/pharmacist/physician... ...CFHP) members and providers. Follows clinical criteria and instructions to approve...Full timeWork at officeDay shift- ...Position Purpose: Analyzes all prior authorization requests to determine medical necessity... ...years of related experience. Clinical knowledge and ability to analyze authorization... ...medical necessity and clinical reviews of authorization requests to determine...Remote work
- ...specialized functions by reviewing, analyzing, and... ...procedures performed in the clinic setting. The primary function... ...Policy and Procedures, Remote Access, and the... ...Experience: Charge Entry Specialist IThree (3) months experience... ...Entry Specialist II:Certificate in medical...Remote workWork at officeImmediate startTrial periodFlexible hoursShift work
$29.62 - $45.31 per hour
...all core functions in the Prior Authorization (PA) Department Coordinate and execute the review and research functions required... ...provider resolutions, etc.) Remote Work This position offers 10... ...over 50 hospitals, over 1,000 clinics and a full range of health and...Remote workMinimum wageFull timeWork experience placementLocal areaShift work- ...management, the part-time Senior Utilization Review Specialist will conduct concurrent and retrospective reviews... ...compliance with medical necessity and payer authorization while collaborating with clinical teams in a fully remote capacity. Key Responsibilities Perform...Remote workPart time
- ...Description Join TriHealth as a Coding Specialist II! At TriHealth , our Medical Coding... ...patient care. In this position, you'll review provider documentation, assign correct... ...research denials, and collaborate with clinical teams to ensure clarity and consistency...Remote workFull timeWork from homeDay shift
- ...ABA Utilization Review SpecialistSpectrum Billing... ...Utilization Review (UR) Specialist to our growing team. The... ...and skills to review clinical information and obtain... ...and continuing authorizations for ABA and related services... ...environment. This is a fully remote or office/home hybrid...Remote workWork at officeFlexible hours
- Job Title: Clinical Review RN, Prior Authorization Location: Cansit onsite in Jericho or remote in Rhode Island License Requirement: If the nurse sits in Rhode Island they need an active RI license and if they sit in NY, they need to be open to getting the RI license....Remote workMonday to FridayFlexible hoursShift work
$21 - $26 per hour
...AmeritaThis role will be responsible for activities relating to the proper initiation, clinical review, submission, and follow up of prior authorizations. This role requires working knowledge of pharmacy benefits and prior authorization process.Schedule: Monday - Friday...Remote workTemporary workMonday to Friday- ...About the Role: The Utilization Review Specialist plays a critical role in ensuring that... ...patient records, treatment plans, and clinical data to determine the appropriateness... ...regulations. Familiarity with insurance authorization processes and healthcare reimbursement...Remote workPart time
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