Remote Clinical Review Nurse - Prior Authorization (RN)
$27.02 - $48.55 per hourCentene Corporation
Centene Corporation is looking for a clinical professional to join their Medical Management/Health Services team. This fully remote position requires active New York State RN licensure. You will analyze authorization requests for medical necessity, coordinate with healthcare providers, and maintain clinical documentation to ensure compliance with guidelines. The role offers a competitive pay range of $27.02 - $48.55 per hour, along with comprehensive benefits including health insurance, tuition reimbursement, and flexible work schedules. #J-18808-Ljbffr
$30.58 - $55.09 per hour
...million members as a clinical professional on our... ...Purpose Routinely reviews more challenging prior authorization requests to... ...Accredited School of Nursing or Bachelor’s degree... ...plan and requires NY RN Licensure. Pay Range... ...approach to work with remote, hybrid, field or...Remote workHourly payFull timePart timeWork at officeFlexible hours- ...IntelliResume seeks a Clinical Review Nurse - Prior Authorization to analyze requests, determining medical necessity in a fully remote role. Ideal for nursing professionals with clinical knowledge... ...nursing school and an active NY RN license. The role involves working...Remote work
- A healthcare staffing company is seeking a Clinical Review Nurse for Prior Authorization Review. This remote role demands conducting reviews, collaborating with healthcare... ...ensuring compliance. Candidates need an active RN license and 2-4 years experience in Prior...Remote workContract work
- ...Elevance Health is seeking a Clinical Review Nurse I. The role includes reviewing prior authorization requests and applying clinical judgement to make decisions. Candidates... .... The ideal candidate will possess a current RN license and experience with Medicare Part A and...Remote work
- ...IntelliResume is seeking a Clinical Review Nurse to perform concurrent health reviews and assess the necessity of care in a remote setting. This role requires a graduate from an Accredited Nursing School and an RN license in California. With 2+ years of acute care experience...Remote workFlexible hours
$80k
...simple, compassionate, and reliable - so no patient is left behind. Make your next role matter. Position Summary The Prior Authorization/Clinical Review Nurse (RN) is responsible for reviewing clinical documentation, evaluating medical necessity, and obtaining prior...Local area- ...CLINICAL REVIEW NURSE - REMOTE ARC Group has multiple positions open for Clinical... ...have PERMANENT US work authorization. Sorry, but we are not considering... ...include cases requiring prior authorization, complex pre-... ...Registered Nurse (RN) license PREFERRED QUALIFICATIONS...Remote workPermanent employmentWork at officeLocal area
- ...Job Description: Clinical Supervisor, UM Denial... ...Position Type: Hybrid (85% remote, 15% onsite in... ...tasks, performance reviews, and disciplinary actions... ...Registered Nursing Program; RN preferred. 2. Minimum... ...Minimum of five years in prior-authorization, appeals & grievance...Remote workPermanent employmentTemporary work
- ...Centene Corp. is looking for a Clinical Review Nurse - Prior Authorization to work remotely. This position entails analyzing prior authorization requests to determine... .... Applicants must have an active New York State RN licensure and a degree from an Accredited School of...Remote workMonday to Friday
- ...Cottage Hospital is seeking a clinical professional for a fully remote role focused on medical... ...requires an active New York State RN licensure and involves analyzing authorization requests to determine... ...providers, conduct clinical reviews, and ensure that members receive...Remote workFlexible hours
- ...solutions provider is seeking a Nurse Reviewer (Registered Nurse) for a remote role in the US. The ideal... ...have over 5 years of clinical experience and must hold an active RN license. Responsibilities... ...records, performing prior authorizations, and documenting findings...Remote workFull time
$50 - $53 per hour
...Job Title: Clinical Review RN (IDR/Appeals) Experience: Open to... ...license*** Location: Remote (can sit anywhere in the US... ...clinical level review, Prior Authorization, and disputed benefits review... ...1. Licensed, Registered Nurse in NYS, required. 2...Remote workLocal areaImmediate startFlexible hours- Molina Healthcare is seeking a qualified RN for clinical review positions in Detroit, Michigan. This... ...at least 2 years of clinical nursing experience and an active RN license.... ...new hire will facilitate reviews of prior authorizations and appeals, ensuring compliance with...Remote job
- ...Management Company LLC is looking for a clinical professional to join their... ...Health Services team in a fully remote role. The ideal candidate will analyze prior authorization requests to ensure medical... ...must hold an active New York State RN license and work according to Eastern...Remote work
$29.05 - $67.97 per hour
...Healthcare in Austin, Texas, is seeking a Clinical Reviewer to assess medical necessity and... ...of care. This role requires an active RN license and offers an hourly pay range... ...Reviewer will handle medical reviews of prior authorizations and claims, ensuring compliance with regulations...Remote jobHourly pay- ...The Utilization Review Clinician is responsible for... ...promptly, using established clinical guidelines and coverage... ...: Conduct prior authorization reviews and/or continued... ...~4-6 years of clinical nursing or therapy experience ~ Active RN, OT, or PT license...Remote workFull timeWork experience placementWork at office
$80k - $90k
...-90k The Medical Review Clinical Appeals Auditor (RN) is responsible for... ...work independently in remote setting with... ...standing and diversified nursing experience... ...similar functions. Prior experience in role... ...management or prior-authorization work, or review of...Remote workFor contractorsImmediate startWork from homeHome officeFlexible hoursShift work$29.05 - $67.97 per hour
...Florida, is looking for a Registered Nurse to facilitate medical reviews and appeals for prior authorizations. The ideal candidate should have 2 years of clinical experience, including utilization... ...medical claims, and possess a valid RN license. This role focuses on...Remote jobHourly pay$31 - $35 per hour
...Clinical Review & Correspondence RN The Clinical Review & Correspondence RN plays... ...as assigned Registered Nurse with active, unencumbered... ...applications This is a 100% remote role, and requires robust... ...–including policy, prior authorization, payment accuracy, and more...Remote workFull timeFlexible hoursShift work$29.05 - $67.97 per hour
Job Summary Utilizing clinical knowledge and experience, responsible for review of documentation to ensure... ...included in a compact RN license. Job Duties... ...of appeals for denied prior authorizations. Includes standard and... ...2 years clinical nursing experience, including...Remote jobHourly payWork experience placementWork at office$28.37 - $36 per hour
...technology, services, and clinical expertise. Our mission is... ...looking for a Clinical Reviewer - RN - PRN (Remote U.S.) to join our growing... ...unrestricted Registered Nurse (RN) License in South Carolina... ...Management (UM), OR Prior Authorization. ~1+ years of knowledge...Remote workContract workWork experience placementReliefWork at officeLocal areaMonday to FridayFlexible hours$25k
...Position: UTILIZATION REVIEW RN- Case Management (IN PERSON... ...Leader of Leaders. Conducts prior authorization reviews to assess whether proposed... ...using evidence-based clinical guidelines. Identifies... ...follow-up. Applies the nursing process and critical thinking...Work at officeRelocation package- ...Recruitment Manager to assess and analyze clinical service requests, verify member benefits, and process prior authorizations. Candidates must have an Illinois state RN license and 1-3 years of... ...clinic settings. This is a fully remote position, offering work within a collaborative...Remote work
- ...medical claim and internal appeals review activities - ensuring... ...procedures, and medically appropriate clinical guidelines. Contributes to... ...QUALIFICATIONS: At least 4 years clinical nursing experience, including broad... ...experience. Registered Nurse (RN). License must be active and...Remote jobWork at office
- ...and patient outcomes. Our talented remote workforce spans the country and... ...requires that the employee is an active RN and based in Alabama. The Supervisor, Clinical Review plays a critical role in... ...criteria. Minimum Qualifications All nurse reviewers will be located and...Remote workContract work
- ## RN Clinical Nurse Coordinator (Hybrid) - EndocrinologyApplyremote type: Hybridlocations:... ...coordinated care. They work both in clinic and remotely, with responsibilities including... ...calls and messages, coordinating prior authorizations, providing patient education, and supporting...Remote workWork experience placementWork at officeMonday to Friday
$85.7k - $128.54k
...innovation. Utilization Management Nurse Lead Responsibilities Reviews reporting to assign tasks to UM Nurses... ...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)...Remote jobImmediate start$80k
...specialty pharmacy, patient services hub, home infusion and nursing network, and third-party logistics provider, we work... ...Elk Gove Village location. POSITION SUMMARY The Prior Authorization/Clinical Review Nurse (RN) is responsible for reviewing clinical documentation,...Full timeLocal area- ...Clinical Nurse Reviewer As one of the fastest growing Independent Physician Associations in Southern California, our organization offers... ...review with the Regional Medical Director(s) high cost prior authorization requests as well as hospital readmissions. Also...Work experience placementFlexible hours
- ...Medix™ is seeking an experienced RN for a Utilization Review role, allowing you to work from the comfort of home. In this contract-to-hire position... ...at least one year of utilization review experience and a nursing degree. Join a mission-driven organization focused on...Remote workContract workWork from home
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