Utilization Management RN - Prior Authorization
$38 - $40 per hourPyramid Consulting, Inc.
Utilization Management RN - Prior Authorization Immediate need for a talented Utilization Management RN - Prior Authorization. This is a 12+ Months Contract opportunity with long-term potential and is located in US (Remote). Job ID:26-31179 Pay Range: $38 - $40/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location). Key Responsibilities: Prioritize assigned cases based on urgency and turnaround time. Review clinical records against applicable criteria and benefits, documenting findings accurately. Communicate requests for missing information and escape cases outside nursing authority. Participate in team huddles, respond to inquiries, and complete administrative tasks. Measure performance through quality and documentation accuracy, productivity, and adherence to policies. Key Requirements and Technology Experience: Required: Graduate from an Accredited School of Nursing or bachelor’s degree in nursing. 2+ years of clinical nursing experience; experience in utilization management, managed care, or prior authorization is preferred. Required: Active RN licensure. Strong critical thinking, organization, attention to detail, and professional communication skills. Proficiency with electronic clinical systems, Microsoft Office, and remote collaboration tools. Experience in case management within required turnaround times. Familiarity with medical-necessity criteria and clinical documentation standards. Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions. Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
- prof
- J-18808-Ljbffr Pyramid Consulting
Vacancy posted 4 days ago
Similar jobs that could be interesting for youBased on the Utilization Management RN - Prior Authorization in New York, NY vacancy
$99.31k - $131.09k
...in our participant’s journey and our Utilization Management team ensures we can provide timely, quality... ...team, the Utilization Management RN Supervisor drives the continuous... ...UM team Assist the team in reviewing prior-authorization requests for medical necessity and appropriateness...SuggestedWelbeHealth
New York, NY1 day ago$75k - $100k
...Utilization Management RN (Registered Nurse) evaluates efficiency, appropriateness, and medical necessity... ...with evidence-based criteria, authorize requested services as appropriate. Our... ...reviewing medical and behavioral health prior authorization requests for medical necessity...SuggestedFor contractorsWork at officeLocal areaImmediate startRemote workWPS—A health solutions company
New York, NY2 days ago$35 - $40 per hour
...service offerings for clinical, case management, member engagement, provider solutions... ..., and analytics. Job Title RN Utilization Management Reviewer Responsibilities... ...decision review for services requiring prior authorization in a variety of clinical areas, including...SuggestedHourly payTemporary workRemote workMonday to FridayFlexible hoursWeekend workSagility LLC
New York, NY1 day ago$68k - $120.5k
...Director of Specialty and Payer Management, the Clinical Reviewer is a... ...medical necessity reviews, authorization compliance, reimbursement... ...healthcare reimbursement and utilization management to reduce denials... ...management, case management, prior authorization, revenue cycle...SuggestedFull timeWork at officeRemote work- Pyramid Consulting is seeking an Utilization Management RN for a 12+ month contract opportunity with a remote location in the United States. The role focuses on prior authorization, clinical document review, and timely case management. Strong nursing credentials and IRN...SuggestedRemote jobContract workImmediate start
- WelbeHealth, LLC. is seeking a Utilization Management RN Supervisor to oversee the day-to-day UM team and drive compliant, cost-effective care for our participants. You will review prior-authorization requests, mentor staff, and collaborate with providers and clinical colleagues...
- ...experienced Registered Nurse for a remote Utilization Management role. You will review cases, assess medical necessity, and support prior authorization decisions while collaborating with... ...teams. The ideal candidate has 3+ years RN experience, ADN required with BSN preferred...Remote job
$35 - $40 per hour
Sagility LLC, a leader in healthcare transformation, seeks an RN Utilization Management Reviewer for a fully remote role. You will perform timely clinical decision reviews for services requiring prior authorization across various clinical areas, applying criteria like...Remote jobHourly pay- ...Summary The primary role of the Utilization Management Nurse is to review and monitor members... ...procedures. This includes providing prior authorizations, concurrent review, proactive discharge... ...Minimum 2 years clinical experience as RN, LPN/LVN required. Minimum 1-year...Contract workWork at officeRemote workWeekend work
Curana Health
New York, NY2 days ago $29.1 - $62.32 per hour
...behalf of a partner company, who manages all applications and next... ...partner is looking for a Utilization Management Nurse Consultant... ...will contribute to effective prior authorization decisions, improved healthcare... ...Registered Nurse (RN) license in the state of residence...Hourly payFull timeTemporary workWork at officeLocal areaRemote workWork from homeMonday to FridayAfternoon shiftJobgether
New York, NY1 day ago$38 per hour
...USA | Alaska, USA + 49 more Bring your utilization management nursing expertise to the development... ...focused on utilization management, prior authorization, medical necessity and payer appeals.... ...within the last three years. An active RN license or another recognized...Hourly payFull timePart timeFor contractorsRemote work$26.01 - $68.55 per hour
...Position Summary Medicare Predetermination Utilization Management Nurse Consultant position:... ...have active current and unrestricted RN licensure in state of residence 1+ years... ...holiday rotation. Preferred Qualifications Prior Authorization or Utilization Management experience...Hourly payFull timeTemporary workWork at officeLocal areaMonday to FridayShift workWeekend workAfternoon shift- ...Job Title: Utilization Management Registered Nurse (UM RN) – SNF / MLTC Location: Remote (Must reside in NY... ...managed care organizations regarding authorizations, medical necessity reviews, and... ...management platforms. Prior experience handling appeals, reconsiderations...Full timeRemote workMonday to Friday
Medix
New York, NY2 days ago - ...Community Care is seeking a Registered Nurse to perform utilization review and coordinate care for members across the health care continuum. You will assess medical necessity, document decisions, and collaborate with physicians and care teams to optimize outcomes. In this...
CommUnityCare
New York, NY9 hours ago - ...A healthcare staffing agency is seeking a Utilization Management RN to work remotely from PA, DE, or NJ. The role involves assessing clinical information, determining medical necessity for services, and collaborating with providers. Candidates should have at least three...Remote workFlexible hoursWeekend workDay shift
The Judge Group, LLC
New York, NY5 days ago - ...Description Job Description Utilization Review Nurse / Clinical Medical Necessity Reviewer (RN) (MUST LIVE IN NY, CT,... ...Department: Utilization Management / Clinical Operations Employment... ...handling precertification/prior authorizations . For California...Remote jobFull timeLive inWork at officeLocal area
Medix
New York, NY4 days ago $85k - $95k
...lifecycle of using the platform. The RN Supervisor, Clinical Operations position... ...at Cohere and report to the Director/Manager of Clinical Operations. You will be... .../LCDs, clinical criteria guidelines Prior Authorization or Utilization Management experience Excellent computer...Hourly payFor contractorsRemote workFlexible hoursCohere Health
New York, NY9 hours ago$35 - $40 per hour
...service offerings for clinical, case management, member engagement, provider solutions... ...employees across 5 countries. Job title: RN Utilization Management Reviewer Job Description:... ...day-to-day timely clinical and service authorization review for medical necessity and...Hourly payTemporary workCurrently hiringRemote workMonday to FridayFlexible hoursWeekend workSagility
New York, NY1 day ago$31 - $35 per hour
Clinical Review & Correspondence RN The Clinical Review & Correspondence RN plays a critical role in supporting utilization management operations by conducting medical necessity... ...the care continuum-including policy, prior authorization, payment accuracy, and more-the...Full timeRemote workFlexible hoursShift work$45 - $45.5 per hour
Overview Job Title: Nurse Case Management Senior Analyst Location: REMOTE Duration: 5-6 Months... ...with the physician treatment plan. Utilizes clinical skills to assess, plan, implement... ...escalated from more junior team members. RN and current unrestricted nursing license...Contract workImmediate startRemote workMonday to FridayAfternoon shift- Utilization Management Nurse RN - Utilization Management - UH Truman Medical Center (7:00a-4:00p, varied days per week) 101 Truman Medical Center Job Location Work From Home-City Tax Exempt Lees Summit, Missouri Department Care Continuity UHTMC Position Type Full time Work...Full timeWork from home
- WPS, a health solutions company, seeks an Utilization Management RN to evaluate medical necessity and appropriateness of services for our Health Plan. This role uses clinical judgment to authorize services and refers questionable cases to medical directors to avoid unnecessary...Remote job
- Humana is seeking a Utilization Management Nurse 2 to apply clinical nursing skills to coordinate, document and communicate medical services and... ...schedule and remote work flexibility. The position requires an RN with a compact license and 3+ years of geriatric care, plus...Remote jobMonday to Friday
- University Health is seeking a Utilization Management Nurse RN for UH Truman Medical Center in Missouri. The role manages resource use, supports care transitions, and advises care teams on documentation and discharge planning to improve patient outcomes. The position emphasizes...Remote job
- NaphCare is seeking an experienced Utilization Management Registered Nurse for a remote-based position supporting an Arizona team. NaphCare delivers... ...years in utilization review/case management, with an Arizona RN license and CPR certification. Some travel may be required....Remote job
- Inland Empire Health Plan (IEHP) is seeking an experienced Utilization Management Nurse to perform prospective, concurrent and retrospective reviews ensuring medical necessity and alignment with UM criteria. Under the UM Manager, you will collaborate with Medical Directors...Remote job
- Ensemble Health Partners is seeking a Virtual Utilization Review Specialist to join our remote team... ...will perform medical necessity reviews, manage denials, and coordinate with FCC and care... .... Qualified candidates hold a current RN license, have at least 1 year in denials...Remote job
- HealthCare Strategies is seeking a Utilization Management RN to work from a HOME OFFICE. This full-time position runs Monday-Friday, 9am-6pm ET, offering a 40-hour workweek and remote work from anywhere in the United States. The role requires an active RN license, at least...Remote jobFull timeWork from homeHome officeMonday to Friday
- Optum is seeking a Per Diem Utilization Management Nurse to review medical records and craft defensible appeal letters. You will extract pertinent case details, adhere to HIPAA, and follow OPAS/Optum guidelines while meeting time expectations. The role offers telecommuting...Remote jobDaily paidLocal area
- Cambia Health Solutions, Inc. is seeking a Utilization Management Nurse to perform prospect, concurrent, and retrospective reviews from a remote... ...Associate or Bachelor's degree in Nursing or a related field, active RN licensure, and approximately 3 years of experience in case/...Remote job
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Utilization Management RN - Prior Authorization. Be the first to apply!
Related searches
- outpatient rn New York, NY
- sedation rn New York, NY
- 1099 rn New York, NY
- ed rn New York, NY
- registered nurse office New York, NY
- rn visa sponsorship New York, NY
- labor & delivery rn New York, NY
- registered nurse remote New York, NY
- mother baby postpartum rn registered nurse New York, NY
- injection rn New York, NY