Remote Prior Authorization UM Nurse Consultant
CVS Health
- Remote job
CVS Health is seeking an experienced RN to support utilization management and prior authorization from a remote setting. You will review requests, determine medical necessity, and coordinate with care teams to ensure high-quality, cost-effective care for members. Required are an active multi-state RN license, 3+ years nursing, and 2+ years in UM or similar. Proficiency with InterQual/MCG and EMR systems is needed. #J-18808-Ljbffr CVS Health
$29.1 - $62.32 per hour
...Utilization Management Nurse Consultant, Specialty Spine Team (Remote) Schedule Monday-Friday,... ...Utilization Management (UM) Spine Team and play a critical... ...'ll review spine-related authorization requests, evaluate... ...What You'll Do Review prior authorization requests for...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from homeMonday to Friday$26.01 - $56.14 per hour
...helping to simplify health care one person, one family and one community at a time. Utilization Management Nurse Consultant (RN) Remote | Prior Authorization | Utilization Management Are you an experienced RN with utilization management or prior authorization experience...Remote workHourly payFull timeTemporary workWork at officeLocal areaWork from home- CVS Health is seeking an experienced Utilization Management Nurse Consultant for the Specialty Spine Team. This remote role focuses on reviewing spine-related authorizations, applying evidence-based criteria, and coordinating with providers and Medical Directors to ensure...Remote job
- Santa Barbara Cottage Hospital is seeking an experienced Utilization Management Nurse Consultant for a remote role with the Spine Team. You will review spine-related authorizations, apply criteria, and collaborate with providers and Medical Directors to ensure medically...Remote job
$26.01 - $56.14 per hour
...a time. Utilization Management Nurse Consultant (RN) - Concurrent Review Remote | Acute Inpatient Utilization Management... ...and regulatory requirements to authorization decisions Partner with Medical... ...Management regulations Prior remote work experience Louisiana...Remote workHourly payFull timeTemporary workWork experience placementWork at officeLocal areaWork from home$82.68k - $96.46k
Clinical Guide: (UM) Utilization Management Nurse (Outpatient Prior Authorization 6,890 - 8,038 $ Important: if an employer asks you to log into their system via... ...policies and workflows. Schedule: This is a full-time, remote position working five 8-hour days, 40 hours per...Remote workFull timeContract workInternshipMonday to Friday$30.37 - $59.21 per hour
...procedures. • Conducts reviews to determine prior authorization/financial responsibility for Molina and... ...• Adheres to utilization management (UM) policies and procedures.... ...education and experience. • Registered Nurse (RN). License must be active and unrestricted...Remote workHourly payWork experience placementWork at office$30.37 - $59.21 per hour
...procedures. Conducts reviews to determine prior authorization/financial responsibility for Molina and... .... Adheres to utilization management (UM) policies and procedures. Required Qualifications... ...education and experience. Registered Nurse (RN). License must be active and...Remote jobHourly payWork experience placementWork at office$66.58k - $142.58k
...Position Summary CVS Aetna is seeking a dedicated Appeals Nurse Consultant to join our remote team. Key Responsibilities Responsible for the review and... ...clinician support as required. This position may support UM (includes expedited), MPO, Coding, or Behavioral Health...Remote workHourly payWeekly payFull timeTemporary workWork experience placementLocal areaMonday to FridayShift work$34 - $47 per hour
...-licensed Utilization Review Nurse to assist our Health Services... ...various Health Plans. This is a remote position for CA-licensed... ...What You'll Do Complete prior authorization/retrospective review of elective... ...least 1 years of outpatient UM experience Experience with...Remote workHourly payLive inWork at officeMonday to FridayShift work$75.3k - $135.4k
...license approval is required PRIOR to starting this role... ...: Supervises Prior Authorization, Concurrent Review, and... .... Monitors and tracks UM resources to ensure adherence... ...clinical review nurses and ensures compliance... ...clearance required NOTE: REMOTE RN candidates may...Remote workFull timePart timeWork experience placementWork at officeFlexible hours- ...Regional MDS / PDPM / CMI / RAI Consultant Are you ready to make a change? We are seeking... ...PDPM / CMI / RAI Consultant to provide remote reimbursement, MDS, PDPM, Case Mix Index... ...support to our long-term care and skilled nursing facilities. This position will...Remote workHourly payLocal areaNight shift
- ...change? We are seeking an experienced Regional MDS / PDPM / CMI / RAI Consultant to provide remote reimbursement, MDS, PDPM, Case Mix Index, and RAI support to our long-term care and skilled nursing facilities.This position will provide regional oversight to ensure accurate...Remote workHourly payLocal areaNight shift
- ...MDS, RUGS, Medicare, Medicaid, and OBRA documentation. Review nursing notes to ensure clarity, accuracy, and alignment with resident... ...Institute? Competitive pay and travel opportunities. Hybrid schedule (remote and on-site). Supportive, collaborative team environment. A...Remote workFull timeContract work
- ...~3+ years of experience as an RN ~ Registered Nurse in state of residence ~ Must have prior authorization utilization experience ~ Experience with Medcompass... ...exp and Medicare/Medicaid knowledge. MUST HAVE UM experience, inpatient utilization management review...Remote work
- ...Utilization Management Registered Nurse (UM RN) We're seeking a dedicated and detail... ...(LCD/NCD policies). This is a fully remote opportunity requiring discipline, accuracy... ...(e.g., MCG). Evaluate and process prior authorization (PA) requests in a timely, compliant...Remote work
$27.5 per hour
...Job Title Pay Rate: $27.50 per hour Work Mode: Fully Remote Duration: September to February with possible extension Responsibilities... ...: Minimum of 3 years of experience in clinical nursing, working with an adult population. Must possess excellent verbal...Remote workHourly pay$62.04k - $102.37k
...Nurse Consultant I (NS) The North Carolina Department of Health and Human Services (DHHS) is... ...registered nurse. This Position Is A Fully Remote Work Option This Is A Home-Based... ...only the most recent application received prior to the closing date will be accepted....Remote workWork experience placementLocal areaNight shift$95k - $105k
...Nurse Consultant Polaris Group, the SNF Clinical branch of Assembly Health, is seeking a dynamic, client-focused Nurse Consultant. We are looking for a clinically trained professional who stays current on federal and state regulations, Medicare requirements, MDS standards...Remote workFull timeWork at office- CVS Health seeks a NICU Utilization Management Nurse Consultant to support high-risk neonatal populations through clinical review, care coordination, and evidence-based decision-making. This remote role requires an active RN license, NICU nursing experience, and familiarity...Remote jobWork from home
$65 - $70 per hour
...Job Title: Cogito Reporting Consultant Location: Remote (U.S. Based, Must Work Pacific Time Hours)... ...Duration: 06/01/2025 - 04/30/2026 Work Authorization: H1B, GC, H4, or U.S. Citizen Job... ...more affordable, streamlined prior authorizations for medications, the...Remote workHourly payH1bShift work- ...Overview Work remote and travel 75%. Optum is a global organization... ...to support payment to the nursing facility Discuss Patient... ...a review of current and prior patient conditions, documents... ...of process flow of UM including prior authorization, concurrent authorization,...Remote workCasual workWork at office
- CVS Health is seeking an Appeals Nurse Consultant to process Medicare Part C appeal requests from members and providers. The role is production-based and remote, with a 40-hour work week and occasional weekend/holiday rotations. Qualified candidates hold an RN license,...Remote job
- CVS Health is recruiting an Appeals Nurse Consultant to process medical necessity for Medicare Part C appeals. The role combines independent and team work in a remote setting, with a 40-hour weekly schedule and occasional weekend/holiday rotations. Required RN licensure...Remote job
- ...extensive Facets experience, particularly around DME claims and authorizations. Must Have's: 1. Experience implementing Medicare LOB on... ...NC. Provide recommendations on priority focus areas based on prior leakage experience. This assumes tiger teams will implement end...Remote workDaily paidContract workShift work
- CVS Health is seeking a Utilization Management Nurse Consultant (Clinical Precertification RN, Medicare) to review clinical cases and determine coverage using evidence-based guidelines in a remote, full-time weekday schedule. You will collaborate with providers and care...Remote jobFull timeWeekday work
- CVS Health is seeking a NICU Utilization Management Nurse Consultant to support high-risk neonatal populations. The role involves clinical... ...care coordination, and evidence-based decision-making across remote settings. You will collaborate with neonatologists, hospitals...Remote job
$72.8k - $130k
...occasional opportunity for remote work based on business needs... ...Sr Utilization Management Nurse in the Boston MA Regional Area... ...a review of current and prior patient conditions, documents... ...of process flow of UM, including prior authorization, concurrent authorization,...Remote workMinimum wageFull timeWork experience placementCasual workLive inWork at officeLocal area$54.1k - $142.58k
CVS Health's Appeals Nurse Consultant role is a full-time, remote-friendly position focused on evaluating Medicare Part C appeals. The job requires an active RN license, strong communication, and solid organizational skills, with a 40-hour workweek and weekend/holiday...Remote jobFull timeWeekend work- CVS Health in Colorado is seeking an Appeals Nurse Consultant to assess the medical necessity of Medicare Part C appeals for members and providers... ...guidelines, and using several computer systems while working remotely. The position requires an active RN license, strong...Remote jobWeekend work
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