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
- RN Utilization Management (RN UM) Overview The RN Utilization Management (RN UM) functions as a support... ...including contact with insurance for authorization as needed. The RN UM ensures high... ...completion of patient records and attachments prior to submitting them to Medi‑Cal via e‑...SuggestedFull timeLocal area
$74.26k - $111.39k
...healthcare and creating a better care experience for all. The Utilization Management (UM) Prior Authorization (PA) Nurse is a full-time role with NeueHealth,... ...: Active California license as a Registered Nurse (RN) Bachelor of Science in Nursing (BSN) preferred but not...SuggestedFull timeContract workWork at office$77.91k - $116.86k
...E2E Alignment Healthcare USA, LLC is seeking a remote Utilization Management Nurse to review prior authorization requests for medical necessity. The role requires a valid LVN or RN license in California, along with experience in nursing and utilization management. Successful...SuggestedRemote work$52 - $57.88 per hour
Central California Alliance for Health is seeking a temporary Registered Nurse to manage prior authorization requests. Ideal candidates will possess a Bachelor's degree in Nursing and have extensive knowledge of managed care systems, particularly Medicare guidelines. The...SuggestedHourly payTemporary workRemote work$85.7k - $128.54k
The Supervisor, Utilization Management (UM), reports to the Manager of UM and oversees the UM department, leading a clinical team and ensuring compliance... ...Nursing program. Licensure: Active, valid, and unrestricted RN or LVN license in California (non‑compact). Upon hire, must...SuggestedRemote jobLocal area$85.7k - $128.54k
...2E Alignment Healthcare USA, LLC is seeking a Supervisor for Utilization Management in California. The role includes overseeing the UM department... ...experience, an accredited nursing background, and must hold an active RN or LVN license in California. Knowledge of Medicare Managed...- 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 job
$30 - $34 per hour
...Overview Utilization Review Nurse - Remote at Astrana Health Location: 600 City Parkway... ...As One 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$66.58k - $142.58k
Behavioral Health Utilization Management Clinician Position Summary Join a team that's dedicated to helping individuals access the right care at... ...Human Services, or Health Services. Associate's degree with RN license and 3+ years of behavioral health experience. Anticipated...Full timeLocal area$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$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$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. Required... ...and experience. Registered Nurse (RN). License must be active and unrestricted...Hourly payWork experience placementWork at officeRemote work- ...Balance Job Summary The Licensed Vocational Nurse (LVN) – Care Management works under the supervision of a licensed Physician to... ...each program Work closely with our internal Referrals and Prior Authorizations department to ensure that patient orders can be successfully...Full timeRemote workHome office
- ...You’ll Be Responsible For Ensures that prior authorization requests are completed in a manner... ...degree in Nursing Working knowledge of managed care, the Medicare D‑SNP and Medi‑Cal... ...minimum of one year of experience in Utilization Management or Case Management Experience...Full timeTemporary workPart timeLive inWork at officeLocal areaRemote work
- ...Career Enhancement is seeking a dedicated Behavioral Health Utilization Management Clinician in California. This role involves using clinical expertise... ...years in a clinical setting, an active behavioral health or RN license, and a passion for improving patient outcomes. A...
$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...Full timeRemote workMonday to FridayShift work$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... ...Education - Registered Nurse (RN) with an active, unrestricted...Work at office$27.61 - $53.83 per hour
...treatments and/or procedures. Conducts reviews to determine prior authorization/financial responsibility for Molina and its members.... ...teams to promote the Molina care model. Adheres to utilization management (UM) policies and procedures. Required Qualifications...Hourly payContract workWork experience placementWork at office$120k
Job Description Primary Function The Team Manager is the leader of the Patient Care Team... ...information system (Vx) and the ability to utilize management reports. Two years’ successful... ...for the Admissions Registered Nurse, RN Patient Care Services Directs all patient...Contract workFlexible hours- RN Care Manager Emergency Room PD Nights The purpose of the Case Manager position supports the... ...and coordinates the functions of utilization management, care progression and care... ...needed to confirm patient status and/or authorization to support the billing process. Collaborates...Local areaNight shift
- ...Doing The Supervisor of Clinical Operations RN supports physicians and clinical staff... ...procedures in collaboration with senior management. Oversees, and as necessary, performs... ...including facilities management, pharmacy, utilization management, quality management, risk...Work experience placement
$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$74.56 - $90.51 per hour
Job Summary and Responsibilities Day Full Time RN Care Coordinator The RN Care Coordinator is responsible for overseeing the... ...be on care coordination communication and collaboration with utilization management nursing physicians, ancillary departments, insurers and post...Hourly payFull time$47 - $55 per hour
...psychiatric disorders. Candidates must possess current RN licensure and demonstrate strong leadership and crisis... ...safety, applying knowledge of psychotropic medications, and utilizing organizational abilities to manage patient care effectively. The position offers...Hourly payFull time- ...Hours:**0**Job Description Summary:**The RN Case Manager, in collaboration with members of the... ....* Substantial recent experience in utilization review and/or discharge planning in an... ...and managed care organization to obtain authorization for care and prevent denials.* Reviews...Daily paidShift work
- 6AM City, LLC is seeking an Emergency Department Case Manager (RN) for a night-shift contract opportunity. This role involves coordinating patient care, performing utilization reviews, and collaborating with clinical teams. The ideal candidate will have an active California...Contract workNight shift
$30 - $34 per hour
...A healthcare services company is seeking an experienced Utilization Review Nurse to work remotely. The ideal candidate must hold an active... ...in California and have experience in outpatient utilization management. Responsibilities include approving or denying medical...Hourly payRemote work$26.41 - $51.49 per hour
...regulations, and collaborating with teams for healthcare delivery. The ideal candidate has an active RN license and at least 2 years of experience in hospital or managed care settings. Competitive pay is offered, ranging from $26.41 to $51.49 hourly based on experience...Hourly pay- ...and Salona County. What you’ll do as a Registered Nurse (RN) Hospice Case Manager : Completes an initial, comprehensive and ongoing assessments... ...illness(es). Provides professional nursing care by utilizing all elements of nursing process. Write and initiate plan of...Flexible hours
$47 - $55 per hour
...Clinical Nurse Program Supervisor (CNPS) RN provides skilled nursing leadership and clinical... ...aim of improving the standard of care. Utilize, train, and promote evidence based... ...Conducts routine rounds Assists with workflow management and problem resolution What you will...Hourly payFull timeFlexible hours
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