Remote Utilization Review RN Prior Authorization Expert
$49.34 - $76.59 per hourProvidence Health & Service
A leading healthcare organization is seeking a Utilization Review RN for a fully remote role in Oregon. Candidates must hold an Oregon Registered Nurse License and have at least 5 years of clinical nursing experience, particularly in collaboration with physicians. This position manages medical management programs to optimize patient care. Competitive salary range for Portland is $49.34 - $76.59. Comprehensive benefits including health care and retirement plans are offered. #J-18808-Ljbffr
- ...NeuroPsychiatric Hospitals is seeking a Utilization Review Nurse (RN) to coordinate patient services across multiple hospitals. The role supports... ...collaborating with teams for better outcomes. Located remotely with a preference for candidates in Indiana, Michigan, or...Remote work
- ...Concierge Home Care is seeking a Utilization Review Specialist (RN) for a remote opportunity. This position requires a Florida RN License, OASIS Certification, and Home Health Coding Certification. You will be responsible for reviewing home health clinical documentation...Remote workFlexible hoursWeekend workWeekday work
$65k - $75k
Gainwell Technologies LLC is seeking a Nurse Reviewer (RN) to perform clinical reviews remotely in the United States. Responsibilities include reviewing... ..., 5+ years of clinical experience, and 2+ years in utilization review or claims auditing. This full-time position...Remote workFull time$35 - $45.94 per hour
...Oscar Health is looking for a Utilization Review Nurse to join their team. The role involves performing... ...care. Candidates must hold an active RN license and have at least one year of... ...utilization review or acute care settings. This remote position offers a competitive pay range...Remote workHourly pay- ...Providence 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 have a strong clinical nursing background with 5 years of experience...Remote work
$67.7k
...A specialized consulting firm is seeking a Medical Claims Reviewer to conduct medical reviews and provide guidance on claims. This remote role requires an active RN license, a bachelor's degree in nursing, and at least five years of clinical experience. Ideal candidates...Remote workFull timeMonday to Friday- ...for clinical member services review assessment processes.... ...Conducts reviews to determine prior authorization/financial responsibility for... ...Molina care model. Adheres to utilization management (UM) policies and... .... Registered Nurse (RN). License must be active and...Remote workWork at office
- ...Carolina is looking for a qualified applicant to perform medical reviews and support medical claims processing. The role involves... ...established clinical guidelines. Applicants must hold an active RN license and have at least two years of clinical experience. The...Remote workFull time
$25.08 - $51.49 per hour
...for clinical member services review assessment processes.... ...Conducts reviews to determine prior authorization/financial responsibility for... ...Molina care model. • Adheres to utilization management (UM) policies and... .... • Registered Nurse (RN). License must be active and...Remote jobHourly payWork experience placementWork at office- ...Santa Barbara Cottage Hospital is hiring a Utilization Review Nurse for a remote position. The role involves gathering clinical information, certifying... ...Ideal candidates will have a strong nursing background with RN licensure and at least 4 years of clinical experience....Remote work
$45.9 - $71.4 per hour
...Description Utilization Review RN - Remote. The RN Care Coord‑Qual Med Mgmt will provide administration of medical management programs that include prior authorization, concurrent hospital and skilled nursing review, appeals and grievance, delegation, medical policy development...Remote workHourly payLocal area$45.9 - $71.4 per hour
...Utilization Review RN - Remote Providence Health Plan caregivers are not simply valued - they're invaluable. Join our team at Providence Health... ...administration of medical management programs for prior authorization. These programs are developed to manage medical expense...Remote workMinimum wageLocal areaShift work- ...Enterprise Services) is hiring a Peer-to-Peer Utilization Review Nurse who will manage complex cases with... ...clinical discussions. A BSN and RN license are required, along with significant... ...experience. The position offers a remote work model with a 32-hour work week on a...Remote work
- ...Appworkshub is seeking a dedicated and detail-oriented Utilization Management Registered Nurse (UM RN) to join our remote healthcare team. In this role, you will conduct inpatient and outpatient utilization reviews, support transitions of care, and ensure compliance with...Remote work
- ...A healthcare staffing agency seeks a Utilization Management RN to evaluate clinical conditions through medical record reviews. The position is remote, requiring candidates to reside in PA, DE, or NJ. Key duties involve applying criteria for medical necessity, collaborating...Remote work
$50 per hour
...Drips.com is looking for an Appeals RN (Temporary) to handle grievances... ...skills and a strong background in utilization management. The position is remote and offers a salary of $50/hr. In this... ...position, you will be responsible for reviewing and processing appeals, performing...Remote workTemporary work$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- ...Specialty Pediatrics* ICU MS Case Management/Utilization Review Pre-Cert Review* Prior Authorizations* Retrospective Review* Admission Criteria... .../National Safety Goals Additional Skills remote UR work CA and Medi-Cal experience/knowledge*Remote work
- ...Kelsey-Seybold Clinic is seeking a Utilization Review Specialist (LVN) to conduct medical reviews... ...necessity for services requiring prior authorization. This role involves liaising with providers... ...utilization review. Flexibility for remote work is provided for Texas residents....Remote workHourly pay
$85.99k - $105.34k
...organization in Oregon is seeking a Utilization Review Nurse for a full-time remote position. The role involves... ...clinical service requests, conducting prior authorization reviews, and collaborating with... ...Applicants should have an active RN license and at least five years of...Remote workFull time- ...Coordinated Care Organization is hiring a part-time remote Utilization Review Nurse. The ideal candidate will be a licensed RN with experience in acute care and... ...review. Responsibilities include reviewing prior authorizations, ensuring quality care, and applying medical...Remote workPart time
$20.38 - $36.44 per hour
...Psychiatric Association Inc seeks a Utilization Review Specialist (LVN) who will... ...for services requiring prior authorization and serving as a liaison for surgery... ...review experience and an active RN license. The position offers flexible remote work options adhering to...Remote workHourly payFlexible hours$65k - $78k
...development. Summary We are seeking a skilled Utilization Review Nurse to conduct prior authorization, prospective, concurrent, and retrospective reviews... ...and stay updated on clinical guidelines. Maintain RN license and meet continuing education requirements....Remote workFull timeContract workWork at officeWork from homeFlexible hours$223.8k - $313.1k
...company is seeking a Medical Director to provide expert clinical reviews and advance patient outcomes. This remote position emphasizes collaboration and structured... .... Join a dedicated team focused on effective utilization management while enjoying a competitive compensation...Remote work- ...solutions provider is seeking a Nurse Reviewer (Registered Nurse) for a remote role in the US. The ideal... ...experience and must hold an active RN license. Responsibilities include... ...reviewing medical records, performing prior authorizations, and documenting findings. This full...Remote workFull time
- ...Overview Title: Clinical Review Nurse – Prior Authorization Review Location: Fully Remote (PST Time Zone - WA/OR Resident... ...Authorization Review to join our Utilization Management team. In this role,... ...Qualifications ~ Active RN license (WA; must be in good standing...Remote workContract work
- ...Management Location: 100% Remote Schedule: M-F 9:00am... ...an Illinois state RN license Assess and analyze... ...eligibility Process prior authorization determinations within... ...Summary Works with the Utilization Management team primarily... ...necessity/utilization review and other utilization...Remote workContract work
- ...Point Health Care Inc. is looking for a Utilization Review Nurse in New York. This role requires... .... Responsibilities include reviewing prior authorization requests, collaborating with healthcare... .... Candidates must have a Compact RN License and at least 3 years of clinical...Remote job
$35 - $40 per hour
...$40.00/hr Location Fully Remote Position Summary The Utilization Review Nurse serves as a key liaison in... ...Responsibilities Review and process prior authorizations and reauthorization requests in... ..., active nursing license (RN, LPN, or LVN) in good standing with...Remote workContract workFlexible hoursWeekend work- ...meet QM objectives Responsibilities: Reviews documentation and evaluates Potential... ...Experience: ~3+ years of experience as an RN ~ Registered Nurse in state of residence ~ Must have prior authorization utilization experience ~ Experience with Medcompass...Remote work
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