Prior Authorization RN - Utilization Management
$74.26k - $111.39kNeueHealth
A healthcare company in Missouri seeks a full-time PA Nurse to oversee the prior authorization process for medical services. The ideal candidate will hold an active RN license in California, possess strong clinical experience, and demonstrate effective communication skills. Responsibilities include evaluating authorization requests and collaborating with healthcare providers to ensure compliance. The estimated salary range is $74,260.46-$111,390.70 annually, with additional health benefits and paid time off. #J-18808-Ljbffr NeueHealth
- ...The RN Utilization Management (RN UM) functions as a support liaison for a variety of UM functions... ...including contact with insurance for authorization as needed. The RN UM ensures high quality... ...of patient records and attachments prior to submitting them to Medi-Cal via e-...SuggestedFull timeLocal area
$85.7k - $128.54k
...opportunities for growth and innovation. Utilization Management Nurse Lead Responsibilities Reviews... ...in concurrent review and/or prior authorization at a managed care organization. Minimum... ...active, valid, and unrestricted LVN or RN license in California (Non-Compact)....SuggestedRemote jobImmediate start$75.3k - $135.4k
...professional on our Medical Management/Health Services team. Centene... ...Purpose: Supervises Prior Authorization, Concurrent Review, and/or Retrospective... ...day-to-day activities of utilization management team. Monitors... ...preferred. License/Certification RN - Registered Nurse - State...SuggestedFull timePart timeWork at officeRemote workFlexible hours- ...Centene Corp. is seeking a Supervisor, Utilization Management (RN) to lead and supervise our Clinical Review team. This role focuses on ensuring appropriate care for our members and promotes adherence to compliance standards through effective team management and continuous...SuggestedRemote workFlexible hours
- ...Ocean State Job Lot is seeking a Registered Nurse for Utilization Management in California. The RN UM will support various UM functions including care coordination, denials management, and insurance authorization processes. Candidates must have an Associate Degree in...Suggested
$75.3k - $135.4k
...Corporation is seeking a Clinical Supervisor to oversee the utilization management team ensuring appropriate care for members. The ideal candidate... ...years of experience in a related field, along with an active RN license in California. This position offers a salary range...Remote work- ...Alignment Healthcare LLC is seeking a Lead Utilization Management Nurse, responsible for reviewing inpatient service requests while leading a team... ...strong communication skills and a valid California LVN or RN license. The role includes mentoring and training, along with...Remote work
$30 - $34 per hour
...Overview Utilization Review Nurse - Remote at Astrana Health Location: 600 City... ...Team What You'll Do Complete prior authorization/retrospective review of elective inpatient... ...UM. Candidates with only case management experience are not a fit. Experience...Hourly payRemote workMonday to Friday$26.35 - $39.53 per hour
.... Job Summary The Concurrent Utilization Review (UR) Nurse is responsible... ...provided to members under a managed care health plan. This role... ...resolve discrepancies in care. Authorization & Payer Communication Process... ...Education: Registered Nurse (RN) or Licensed Vocational/...Hourly payWork at officeRemote work$30.37 - $59.21 per hour
...guidelines. Responsibilities include analyzing service requests, conducting prior authorizations, and collaborating with teams to optimize member care. The ideal candidate holds an active RN license and brings at least 2 years of experience. Molina offers a competitive...Hourly pay$26.35 - $39.53 per hour
Job Summary The Concurrent Utilization Review (UR) Nurse is responsible... ...provided to members under a managed care health plan. This role involves... ...discrepancies in care. Authorization & Payer Communication... ...Education: Registered Nurse (RN) or Licensed Vocational/Practical...Hourly payWork at office$26.35 - $39.53 per hour
NeueHealth is seeking a Concurrent Utilization Review Nurse responsible for real-time clinical reviews to ensure the medical necessity of healthcare services. The role includes conducting assessments, coordinating with providers, and collaborating with the Medical Director...Remote jobHourly pay$27.61 - $53.83 per hour
Molina Healthcare is seeking a dedicated professional to provide support for clinical member services in California. The role includes assessing services to ensure compliance with regulations and optimizing member outcomes through effective collaboration and review processes...Hourly payWork at office$44.42 - $61.2 per hour
...Position Summary Registered Nurse (RN) – Care Management – hybrid remote and in-field in Riverside, CA and surrounding areas. Responsible for... ...homelessness, at risk for avoidable hospital or ED utilization, adults at risk of LTC institutionalization, nursing facility...Hourly payLocal areaRemote work$26.41 - $51.49 per hour
...procedures. Conducts reviews to determine prior authorization/financial responsibility for Molina... ...the Molina care model. Adheres to utilization management (UM) policies and procedures.... ...and experience. Registered Nurse (RN). License must be active and unrestricted...Hourly payWork experience placementWork at officeRemote work- ...Description Responsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality... ...Nurse License upon hire. 3 years experience in utilization management and/or case management. 3 years clinical experience in hospital...Work at office
$37.5 - $40 per hour
The Vital Care Case Manager is responsible for the assessment, treatment... ...Nursing Program. Current CA RN, or LVN license, current CPR... ...experience. 2-3 years of utilization or HMO experience preferred.... ...patient case managers and Prior-Authorization nurses Identifies and...Hourly payFull timeRelocation packageFlexible hours$27.61 - $53.83 per hour
...treatments and/or procedures. Conducts reviews to determine prior authorization/financial responsibility for Molina and its members.... ...multidisciplinary teams to promote the Molina care model. Adheres to utilization management (UM) policies and procedures. Required Qualifications At...Hourly payContract workWork experience placementWork at office$74.29k - $111.43k
...Job Summary The Concurrent Utilization Review (UR) Nurse is responsible... ...provided to members under a managed care health plan. The role involves... ...discrepancies in care. Authorization & Payer Communication Process... ...Education – Registered Nurse (RN) with an active, unrestricted...Work at office$43 - $58 per hour
...compassionate Triage Registered Nurse (RN) to join our Monterey team. This role is critical in managing chemotherapy side effects and... ...pharmacies and obtain prior authorizations as required.Complete referral... ..., and medications accurately.Utilize community and online...ReliefRemote workShift work- ...Engineering Inc. (EEI) is seeking a Concurrent Utilization Review Nurse responsible for real-time... ...of healthcare services provided under a managed care plan. This role involves... ...continued stays. The ideal candidate is an RN with a California license and at least 2...
- E2E Alignment Healthcare USA, LLC seeks a Utilization Management Nurse Lead to oversee nurse assignments and ensure timely operations. The role includes supporting team processes and participating in quality audits. The ideal candidate has substantial experience in concurrent...
- ...POSITION SUMMARY RN Case Manager POSITION DUTIES Discharge planning; Utilization review; Dealing with all payers, including uninsured and homeless; Completing Initial... ...Must be familiar with Interqual Must have prior Dignity experience to be considered LENGTH OF ASSIGNMENT...Immediate startShift workWeekend work
$51.31 - $78.76 per hour
...Pay Range: CASE MANAGER, RN - $51.31 to $78.76 Job Summary The RN Case Manager-Pre Access is responsible for screening, coordinating, and... ...-based clinical practice is essential. Advanced experience utilizing InterQual required. Knowledge and Skills Develops, maintains,...$63.73 - $92.4 per hour
RN Supervisor - Primary Care & Urgent Care MemorialCare | Posted Mar 12 Full-time California... ...operations of the clinical site(s) utilizing the five (5) Simply Better steps with... ...department. In partnership with Practice Manager, recognize staff performance, manage, and...Full timeWork experience placementShift work$125.4k - $179.3k
...resource navigation, care transitions, symptom management, and medication management support. This... ...clinical visits—reducing avoidable utilization, closing gaps, and improving quality... ...Work, or related field. Registered Nurse (RN) required. 5+ years’ experience in care...Local area$98.55k - $147.83k
...Role We are seeking a dynamic and experienced Manager of Care Management to lead a high‑performing... ...regulatory compliance, and optimal resource utilization across the continuum of care. This position is ideal for a proven RN leader who is passionate about coaching teams...Remote jobWork at office- Manager, RN - Surgery Administration, Full-time, Dayshift Job Summary: Creates an environment... ...nursing and ancillary personnel utilizing both professional and supervisory discretion... ...when determines they are necessary. Authorizes and assigns overtime to personnel when...Full timeWork experience placementShift workDay shift
$58 per hour
...compassionate work environment. Qualifications RN License (Required) Hospice care: 1 year (... ...) Full Job Description Hospice RN Case Manager ANCHOR HEALTH, a new premier hospice... ...). Provides professional nursing care by utilizing all elements of nursing process. Assesses...Monday to Friday$57 - $60 per hour
...Care Provides professional nursing care by utilizing all elements of nursing process and as... ...Admission Registered Nurse when assigned by a manager or designee and assumes responsibility to... ...League for Nursing and a current RN license. Minimum of two years’ experience...Hourly pay
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