Remote Clinical Review Nurse - Prior Authorization
Centene Corporation
Centene Corporation is seeking a nurse to analyze prior authorization requests for medical necessity and appropriate level of care. The role supports coordination with providers and medical teams to ensure timely, cost-effective care across the United States.
The position offers full-time hours, remote work from anywhere in the U.S., with weekend coverage approximately every six weeks and occasional holidays. LPN or RN licensure is required, with RN preferred for hospice/ managed care experience.
#J-18808-Ljbffr$2,300 per month
...The Clinical Review Nurse (RN) supports the organization’s care management function by conducting... ...outcomes for members. This is a remote role open to candidates residing in... ...processing of pre-certification, prior authorization, and concurrent review requests....Remote workWork at office- ...Position Title: Clinical Review Nurse - Prior Authorization Work Location: Remote; nationally sourced within approved U.S. states. Must be available during standard business hours for the assigned team. Assignment Duration: 12 Months possibility of extension or...Remote workWork at officeMonday to Friday
- ...Position Purpose: Analyzes all prior authorization requests to determine... ...from an Accredited School of Nursing or Bachelor's degree in Nursing... ...experience. Clinical knowledge and ability to analyze... ...medical necessity and clinical reviews of authorization requests to...Remote work
- Position Title Clinical Review Nurse - Prior Authorization Work Location Remote - PST and CST (No CA and NY candidates please) Assignment Duration 12 Months Work Schedule Sunday - Thursday 7am - 4pm 8am - 5pm 9am - 6pm 10pm - 7pm Shifts depend on what...Remote workFlexible hoursShift work
$27.02 - $48.55 per hour
Position Purpose Analyzes all prior authorization requests to determine... ...have the flexibility to work remotely from their home anywhere within... .... This team performs clinical reviews for medical and behavioral... ...from an Accredited School of Nursing or Bachelor's degree in Nursing...Remote workHourly payFull timePart timeWork at officeWork from homeMonday to FridayFlexible hours$35 - $40 per hour
...Job Title: Clinical Prior Authorization Reviewer Job Description This role focuses on reviewing prior authorization requests to determine medical... ...or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is...Remote workContract workTemporary workShift work- ...Clinical Review Nurse - Remote ARC Group has multiple positions open for Clinical Review Nurses! These... ...currently have PERMANENT US work authorization. Summary Statement: The Clinical... ...care which may include cases requiring prior authorization, complex pre-payment...Remote jobPermanent employmentWork at officeLocal area
$35 - $40 per hour
...Clinical Prior Authorization Reviewer This role focuses on reviewing prior authorization requests to determine the medical necessity of services and... ...or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated...Remote jobContract workTemporary workWork at officeShift work- ...Job Description: Clinical Supervisor, UM Denial... ...Position Type: Hybrid (85% remote, 15% onsite in... ...daily tasks, performance reviews, and disciplinary actions... ...Registered Nursing Program; RN preferred... ...Minimum of five years in prior-authorization, appeals & grievance,...Remote workPermanent employmentTemporary work
- ...Maryland, Virginia, (or) DC states Role: HEDIS Clinical Review Nurse W2 Contract: 5 Months Location: Primarily remote ~ Requires mandatory on-site training in... ...absences). Preferred Qualifications: Prior experience performing HEDIS overreads and high...Remote workContract workWork at officeLocal area
- ...5 months Work Location: Primarily Remote (Hybrid focus for candidates residing... ...leading healthcare organization as a Clinical Medical Review Nurse supporting the annual HEDIS retrospective... ...). Preferred Qualifications: Prior experience performing HEDIS overreads...Remote workContract workWork at officeLocal area
$27.02 - $48.55 per hour
...Business Area: Clinical & Care Management Job Type... ...: Performs concurrent reviews, including determining... ...This position is fully remote/work from home. Applicants... ...a compact/multi-state nursing licensure active and in... ...Ideal applicant will have prior UM experience...Remote workHourly payFull timePart timeWork at officeWork from homeMonday to FridayFlexible hoursWeekend work- ...Profile Summary Location: 100% Remote, Source candidates from EST preferred... ...delivering timely, accurate, and clinically appropriate authorization reviews while maintaining compliance, quality... ...- Required: Accredited School of Nursing or Bachelor's degree in Nursing - Preferred...Remote workHourly payShift workWeekend work
$71.1k - $97.8k
...Skills Research Institute is seeking a Pre-Authorization Registered Nurse to join their team. This role involves reviewing prior authorization requests to ensure appropriate... ...licensed RNs with a minimum of two years clinical experience. The compensation ranges from $7...Remote jobWork from home- ...Job Title: Clinical Review Nurse - Concurrent Review Location:Remote- Nationally but must have Compact license if not in KY (ok with all time zones but must work EST) Duration : 6 months Shift : Mon- Fri 8-5pm EST Job Description: Position Purpose...Remote workShift work
- ...Position Title : Clinical Review Nurse - Concurrent Review Work Location : Remote - Central, Mountain or Pacific preferred Assignment Duration : 6 months... ...of care remains medically appropriate. ~ Authorization documentation: Complete authorization activities...Remote workTemporary work
- ...Clinical Medical Review NurseAmpcus Inc. is a certified global provider of a broad range of Technology... ...).Qualifications:Registered Nurse (RN) – active state or compact license... ...professionalism and a collaborative mindset.Remote work environment with minimal physical...Remote work
- ...Clinical Medical Review NurseWe are seeking Licensed Practical Nurses (LPN) or Registered Nurses (RN) to join the Quality team as Clinical Medical Review Nurses. This is a hybrid contract position requiring both remote work and regular onsite presence at the Canton, MD...Remote workContract workWork at office2 days per week3 days per week
- ...Blueprints Enterprise Architecture EnterpriseTransformation. Position: Clinical Medical Review Nurse HEDIS Retrospective Project Locations: Columbia MD Work Arrangement: Primarily Remote Occasional Provider-Site Visits Position Overview We are seeking experienced...Remote workContract work
$41.5 per hour
...Job Title: Clinical Medical Review Nurse Location: Baltimore, MD Type: Contract Compensation: $41.50 per hour Work Model: Hybrid – onsite and remote Hours: 40.0 hours per week Responsibilities Receives, researches, reviews, and analyzes professional...Remote workHourly payFull timeContract workZero hours contractWork at officeLocal area$40 - $43 per hour
...Job Description Job Description Title: Clinical Review Nurse – Medicaid Denial Letters Location: Fully Remote – Florida Pay: $40.00–$43.00 per hour, based... ...supporting Medicaid health plan operations. Prior experience working in a remote healthcare position...Remote workHourly payFlexible hoursShift work$65k - $78k
...Your Role In Our Mission Review admissions, procedures,... ...and production goals. Use clinical criteria for decision-making... .... Assist in training new nurses, provide feedback, and stay... ...clinical experience. ~1+ year in prior authorization reviews using InterQual or...Remote workFull timeWork at officeWork from homeFlexible hours- ...Centene Corporation is seeking a Nurse Reviewer for remote work in the United States. The role involves performing concurrent reviews to determine appropriate level of care and discharge planning, with emphasis on medical necessity and care setting. Requires active...Remote work
- Centene seeks a Clinical Review Nurse for concurrent reviews to evaluate care and support discharge planning. Ideal for those with acute rehab, SNF, or LTC experience. Remote option with Arizona residency requirements. Responsibilities include reviewing acuity, coordinating...Remote jobFlexible hours
$27.02 - $48.55 per hour
...About This Role The Clinical Review Nurse performs concurrent reviews to assess members' overall health, evaluate medical necessity, and contribute... ...Highlights Pay: $27.02 - $48.55 per hour Location: Remote, NC Schedule: Full Time, Day shift What You'll Do...Remote workHourly payFull timeFlexible hoursDay shift$35.8 - $39.1 per hour
...Clinical Review Nurse - Concurrent Review Immediate need for a talented Clinical Review Nurse - Concurrent Review. This is a 06+months contract... ...opportunity with long-term potential and is located in U.S(Remote). Please review the job description below and contact me...Remote workContract workLocal areaImmediate start$35 - $40 per hour
...Clinical Chart Reviewer This role involves reviewing clinical charts for medical necessity in inpatient... .... Overtime and holiday work require prior approval and are not typically... ...Workplace Type: This is a fully remote position. Application Deadline:...Remote jobContract workTemporary workWork at officeMonday to Friday- ...Humana seeks a Pre-Authorization Nurse to review prior authorization requests for appropriate care and setting, applying... ...policies. This role requires independent clinical judgment and strong decision-making abilities. Remote position from LA with a choice of schedules...Remote workShift work
- ...Humana is seeking a Pre-Authorization Registered Nurse for a remote, full-time role based in Virginia. The RN will review prior authorization requests, determine appropriate care settings... ..., plus at least two years of varied clinical nursing experience in acute, skilled,...Remote workFull time
$21 per hour
...viability of the claim for further review in a production environment.... ...Key Responsibilities: Clinical Case Reviews - 75% Perform... ...Coding Certificate and/or Nursing Licensure Complete compliance... ...could change to hybrid or remote after the 8-week training....Remote workHourly payFull timeContract workTemporary workMonday to Friday
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