Remote RN Care Review Clinician - AZ UM Prior Authorization
$26.41 - $51.49 per hourMolina Healthcare of Illinois
- Remote job
Molina Healthcare is seeking an RN with at least 2 years of experience in hospital acute care for a remote role supporting the Arizona State Plan. Key responsibilities include assessing inpatient services, analyzing clinical requests, and collaborating with healthcare teams to ensure optimal outcomes. The position requires excellent organizational, problem-solving, and communication skills. A valid RN license in Arizona is mandatory, and candidates with a Behavioral Health background are preferred. Pay range is $26.41 - $51.49 hourly. #J-18808-Ljbffr Molina Healthcare
- ...clinical member services review assessment processes.... ...integrated delivery of care across the continuum. Contributes... ...reviews to determine prior authorization/financial... ...utilization management (UM) policies and procedures... .... Registered Nurse (RN). License must be active...Remote jobWork at office
$26.41 - $51.49 per hour
...clinical member services review assessment processes.... ...integrated delivery of care across the continuum. Contributes... ...reviews to determine prior authorization/financial... ...utilization management (UM) policies and procedures... ...experience. Registered Nurse (RN). License must be...Remote jobHourly payWork experience placementWork at office$26.41 - $51.49 per hour
...integrated delivery of care across the continuum,... ...candidate with an Arizona RN licensure. The ideal... ...have experience with UM and prior authorization with both inpatient... ...our interview process. Remote position, must reside... .... Conducts inpatient reviews to determine financial...Remote workHourly payWork experience placementWork at officeMonday to FridayWeekend work$90k - $100k
...health, unburden clinicians, align... ...business of health care, transforming it... ...are looking for a RN Concurrent Review . If you are passionate... ...Purpose The UM Nurse is responsible... ..., inclusive of prior authorization, concurrent and... ...hybrid or fully remote work arrangement...Remote workWork at office3 days per week$34 - $47 per hour
...UM Review Nurse - LVN Department: HS - UM Employment Type: Full Time... ...shifts per week. This is a remote position for CA-licensed... ...Entrepreneurial Provider and Care Teams Operate with Integrity... ...Team What You'll Do Complete prior authorization/retrospective review of elective...Remote workHourly payFull timeLive inWork at officeMonday to FridayShift work- ...experience, responsible for review of documentation to ensure medical... ...and appropriate level of care utilizing MCG/InterQual, state... ...review of appeals for denied prior authorizations. Includes standard and... ...experience. Registered Nurse (RN). License must be active and...Remote jobWork at office
$28.37 - $36 per hour
...looking for a Clinical Reviewer - RN - PRN (Remote U.S.) to join our growing... ...and appropriateness of care; assess if the medical record... ...Utilization Management (UM), OR Prior Authorization. ~1+ years of... ...experienced and caring leaders, clinicians, pioneering...Remote workContract workWork experience placementReliefWork at officeLocal areaMonday to FridayFlexible hours- ...Job Title: Care Review Clinician I Location: 100% Remote Duration: 3 Months+ (temp to hire) Schedule... ...utilization management (UM) reviews, including prior authorization of outpatient services, to... ...Active, unrestricted California RN or LVN license required....Remote workTemporary work
- ...Administration, Inc. is seeking an RN Clinician to provide utilization management services in a remote role from Virginia. The ideal... ...license and over 3 years of acute care experience. Responsibilities include prior authorization reviews, care coordination, and managing...Remote work
$77.91k - $116.86k
...Healthcare USA, LLC is hiring for a remote Utilization Management (UM) Nurse position focused on pre-service reviews. This role requires active California LVN or RN licensure and involves reviewing prior authorization requests to ensure quality care. Candidates should have...Remote work- ...MVP Health Care is seeking a remote Sub-Acute RN UM Reviewer to join its Utilization Management team. In this vital role, you will conduct clinical reviews ensuring compliance with Medicare guidelines and support high-quality patient outcomes. The role requires current...Remote work
- ...resource support for HCS-UM team to support... ...following 15 states-AZ, FL, GA, ID, IA, KY,... ...procedures. Conducts prior authorization reviews to determine... ...multidisciplinary teams to promote Care Model Adheres to... ...setting LPN or RN The ability to work remote in a high pace/high...Remote workLive inWork at officeWeekend work
- ...Caring, Researching, and Teaching Top... ...Registered Nurse Clinician to join our busy,... ...collaborative discussions and review case findings of... ...Obtains prior authorization for medications as... ...preferred Active RN License... ...with rotation to remote clinics as business...Remote workFull timeTemporary workWork at officeMonday to FridayFlexible hours
$27.61 - $53.83 per hour
Molina Healthcare is seeking support for clinical member services review in Sacramento, California. This role verifies that services... ...clinical guidelines and regulations, promoting cost-effective member care. Responsibilities include assessing member services, analyzing...Hourly pay$69.38k - $92.28k
...Join Us in Shaping the Future of Health Care At MVP Health Care, we're on a mission... ...the Opportunity As a Sub-Acute RN UM Reviewer-Medicare, you will play a vital role in... ...Where you'll be: Location: Remote Pay Transparency MVP Health Care...Remote work- Humana is seeking a Prior Authorization RN to join the Wisconsin Medicaid Market team, primarily working... ...home. You will be responsible for reviewing PA requests, ensuring compliance with... ...and a minimum of two years in clinical care. The position offers flexible hours...Remote jobWork from homeFlexible hours
- ...Nurse Position is remote, but candidates... ...candidate will have some UM experience. MCG... ...delivery of care across the continuum... ...Conduct inpatient reviews to determine financial... ...May also perform prior authorization reviews and/or... ...Registered Nursing (RN) license in good...Remote workLocal area
$28.37 - $36 per hour
...Acentra Health, LLC is seeking a Clinical Reviewer - RN - PRN (Remote U.S.) to interpret patient records, ensuring medical necessity and appropriateness of care. Ideal candidates will possess an RN license and relevant clinical experience. This position offers flexible...Remote workReliefFlexible hours- ...health and make it easy. AZ Blue offers a variety of... ...as hybrid, onsite or remote. While the majority of our... ...insurance, or other health care related field (All... ...professional, including RN, LPN, LPT, LBSW, LMSW, or... ...in claims retrospective review, utilization management,...Remote jobWork experience placement1 day per week
- ...Become a part of our caring community Are you... ...Nurse (RN) Intern will report... ...medical necessity reviews for behavioral health... ...reviews of prior authorization requests to determine... ...liaison between clinicians, internal departments... ...in a remote environment. Proficiency...Remote workFor contractorsApprenticeshipInternshipWork from homeHome officeWeekday work
- ...Job Title: UM Reviewer Nurse (California License) – Must be licensed in California- Remote Opportunity Work Hrs : (8am – 5pm PDT) would like to include evening, weekend... ...settings, identifying member needs, planning for care, monitoring the efficacy of interventions, and...Remote workContract workTemporary workImmediate startAfternoon shift
$24 - $46.81 per hour
...for clinical member services review assessment processes. Responsible... ...integrated delivery of care across the continuum. Contributes... ...reviews to determine prior authorization/financial responsibility for... ...Adheres to utilization management (UM) policies and procedures. Required...Remote jobHourly payContract workWork experience placementWork at office- ...Health & Services is hiring a Utilization Review RN for a remote position focused on administering medical management programs, including prior authorization and review processes. Candidates must... ...Washington. This role encompasses care coordination and discharge planning,...Remote job
$35 - $40 per hour
...Location Fully Remote Position Summary... ...The Utilization Review Nurse serves as a... ...delivery of home health care. This role... ...Review and process prior authorizations and reauthorization... ...provide feedback to clinicians on medical necessity... ...nursing license (RN, LPN, or LVN) in...Remote workContract workFlexible hoursWeekend work$49.34 - $76.59 per hour
A leading healthcare organization is seeking a Utilization Review RN for a fully remote role in Oregon. Candidates must hold an Oregon Registered Nurse... ...manages medical management programs to optimize patient care. Competitive salary range for Portland is $49.34 - $76.59....Remote job$30 - $34 per hour
...Overview Utilization Review Nurse - Remote at Astrana Health Location... ...hour Department: HS - UM This is a fully remote position... ...Provider and Care Teams Operate with Integrity... ...What You'll Do Complete prior authorization/retrospective review of elective...Remote workHourly payMonday to Friday$153.49k - $202.43k
...week; the remaining days may be remote. DESCRIPTION UC San Diego... ...by 10% of U.S. hospitals. The Prior Authorization UM Case Manager will manage the... ...teams to facilitate appropriate care and manage authorization... ...California. Minimum two years recent RN experience in prior...Remote workHourly payContract workMonday to FridayDay shift1 day per week$35.29 - $47.37 per hour
...work-life balance ~ Remote work options and Flexible... ...Aim of health care reform: member engagement... ...time REMOTE Utilization Review Nurse . If you are a... ...Work Location: OR, CA, AZ, TX, FL Salary: $3... ...management. Reviews prior authorization requests for appropriate...Remote workHourly payPart timeCurrently hiringWork at officeLocal areaWork from homeMonday to FridayFlexible hours$34 - $40 per hour
...hr - $40.00/hr Remote (Compact Licensure... ...to LPN's & RN's About the Role... ...experienced Utilization Review Nurse to... ...patient care through home-based... ...review patient authorizations, ensure compliance... ...’ll Do Process prior authorization... ...Provide feedback to clinicians on medical...Remote workFull time- ...and make it easy. AZ Blue offers a variety... ...hybrid, onsite or remote. While the... ...the completion of prior authorization (PA) requests to meet... ...requirements and ensures all reviews utilize nationally... ...), and Affordable Care Act (ACA) members.... ..., including RN or LPN....Remote workFull timeWork experience placementWork at office1 day per week
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