RN Utilization Review Clinician - Prior Authorization Expert
$26.41 - $61.79 per hourMolina Healthcare of Illinois
Molina Healthcare is seeking a qualified clinician in New York to support clinical member services. This role involves assessing service requests and ensuring compliance with clinical guidelines. The ideal candidate will have a Registered Nurse (RN) license and at least two years of relevant experience. You will collaborate with various teams to maximize member outcomes. Compensation ranges from $26.41 to $61.79 hourly, depending on experience. Join us in providing quality care! #J-18808-Ljbffr Molina Healthcare
$26.41 - $61.79 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... ...experience. Registered Nurse (RN). License must be active and...SuggestedHourly payWork experience placementLive inWork at office- 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...SuggestedRemote jobFlexible hoursWeekend workWeekday work
- ...provider in the United States is seeking a Physician to provide utilization review services. The successful candidate will utilize clinical... ...compliance with guidelines. This role includes reviewing prior authorizations and appeals, maintaining proper licensure, and tackling...Suggested
$35 - $45.94 per hour
Oscar Health is looking for a Utilization Review Nurse to join their team. The role involves performing medical necessity reviews and working with... ...ensure quality patient care. Candidates must hold an active RN license and have at least one year of experience in...SuggestedRemote jobHourly pay$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...SuggestedRemote jobFull timeMonday to Friday$35 - $45 per hour
...IntePros is seeking a Remote Utilization Review Nurse serves as a key... ...Functions Process patient prior authorization and reauthorization requests... ...requirements. Provide feedback to clinicians on accurate assessments,... ...nursing program (RN, LPN, or LVN). Minimum of...Contract workRemote workWeekend 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 job
$36 - $38 per hour
...lifecycle of using the platform. The Lead RN Reviewer in Service Operations position is a... ...-to-day oversight and direction to clinicians Assist in addressing any case... ...providers and handles over 12 million prior authorization requests annually. Its responsible AI...Remote jobHourly payFlexible hours$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 jobReliefFlexible hours- ...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
- Position Summary The Utilization Review Nurse is responsible for ensuring the receipt... ...inpatient or outpatient authorizations. The role receives and reviews prior authorization requests for specific... ...clinical nursing experience as an RN, preferably in a hospital setting...Remote jobWork at officeFlexible hours
$1,150 - $1,450 per month
...Position: Health Insurance Expert Type: Contract Compensation... ...Role Responsibilities Review and evaluate AI-generated... ...workflows, including prior authorization decisions and regulatory audits... ...processing, medical underwriting, utilization management, benefits...Hourly payContract workSummer workRemote work- The role offers innovative consulting solutions and a chance to work remotely. Candidates who are detail-oriented and passionate about medical review are encouraged to apply. #J-18808-Ljbffr Broadway Ventures LLCRemote job
- ...health, access to care and appropriate utilization of resources, balanced with the patient’... ...prevention Coordination with payers to authorize appropriate level of care and length of... ...oversee work delegated to Central Utilization Review LVN/LPN Case Manager and/or Central...Work at officeRemote work
- ...Scheduled Weekly Hours:**40**Position Overview*** Performs chart review of identified patients to identify quality, timeliness and... ...determination.* Gathers clinical information to conduct continued stay utilization review activities with payers on a daily basis. Performs...Full timeTemporary workPart timeWork at officeLocal areaImmediate startFlexible hoursNight shift
- ...Healthcare, Inc. is hiring a full-time Licensed Medical Review Nurse to conduct reviews of medical documentation while working... ...least 2 years of clinical nursing experience, including utilization review, and a valid RN license in Florida or Kentucky. Strong analytical skills...Remote jobFull time
- ## Clinical Denials Utilization Review RN - FT - Day - Utilization Resource Management Pennington NJApplylocations: RMCtime type: Full timeposted... ...employees? NoIf set to YES, then this position has the authority (delegated) to hire, terminate, discipline, promote or...Full timeTemporary workPart timeFlexible hours
- ...Description We are seeking an experienced Utilization Review Nurse to join our team in a hybrid role... ...companies to ensure coverage and authorization of services. Document all review activities... ...meetings. Qualifications Active RN license in the state of New York. Minimum...Work at officeRemote workMonday to FridayFlexible hours
- CVS Health is looking for a highly skilled Utilization Management Nurse (RN) for a remote position. In this role, you will ensure patients receive appropriate healthcare services through reviews of clinical cases and collaboration with providers. The ideal candidate will...Remote job
- ...Texas Harbor Health is seeking a dedicated Utilization Management (UM) LVN. The UM LVN supports prior authorization and utilization review activities to ensure timely and... ...creating an inclusive environment for all clinicians and teammates and actively encourage applications...Remote jobLocal areaMonday to FridayShift work
- ...notifications, obtaining necessary certifications and authorizations, and liaising with third-party payers. The ideal... ...of 4-5 years in acute care and 1-2 years in utilization review. This position requires a Georgia RN license and a commitment to effective patient advocacy...
- Capital Health is seeking a Clinical Denials Utilization Review RN in New Jersey to manage utilization reviews related to inpatient care. The role involves overseeing denial and appeal processes, ensuring compliance with CMS guidelines, and requires a minimum of five years...
- ...State University Wexner Medical Center seeks a Clinical Financial Case Manager - RN to implement and support their mission and policies. The role involves securing complex pre-authorizations, appealing clinical denials, and requiring a keen understanding of clinical...
$90 per hour
...Summers , and Jack Dorsey . Position: Clinicians Survey – Ambulatory & Community Care... ...Physician (MD/DO) , Registered Nurse (RN) in a clinical care delivery role, or Care... ...out to: ****@*****.*** PS: Our team reviews applications daily. Please complete your...Contract workSummer workRemote work- ...licensure, or eligible for licensure as an RN in the Commonwealth of Pennsylvania.... ...Conducts inpatient pre‑admission and admission review for Medicare and Medicaid beneficiaries,... ...problem‑solving regarding appropriate utilization of resources. Promotes the use of best practice...Full timeWork experience placementWork at officeLocal areaImmediate startNight shift
$65 - $95 per hour
...coordination, and structured healthcare workflow review. This role supports current and... ...Educational Background Nursing education, RN/LPN/LVN qualification, BSN, MSN, or... ...clinical training is helpful Active or prior nursing licensure is highly relevant depending...Remote jobHourly payWeekly payJob sharingContract workPart timeFor contractorsFlexible hours- ...patients' physical health. Utilizes the nursing process in... ...of the treating clinician, in accordance with licensure... .... Assists in the prior authorization process for clinical... ...refills for Provider review and approval. Nurses... ...Current NY State RN License required. Basic...Hourly payContract workWork at officeLocal areaImmediate startFlexible hours
- ...patients' physical health. Utilizes the nursing process in... ...of the treating clinician, in accordance with licensure... .... Assists in the prior authorization process for clinical... ...insurance carriers. Includes review of Provider... ...Current NY State RN License required. Basic...Work at officeImmediate start
$85.7k - $128.54k
## Utilization Management Nurse, Lead (Inpatient | Remote | Must have California LVN / RN License)Applyremote type: Fully Remotelocations: Anywhere in... ...Nurse Lead is responsible for reviewing requests for inpatient and prior authorization services for all plan members....Remote jobImmediate startMonday to Friday- ...Utilization Review Nurse VillageCare is looking for a self-motivated and passionate RN as Utilization Review Nurse for a Full-Time position. This is an exciting and dynamic position from the comfort of your own home as you will be responsible for the assessment of member...Full timeWork from home
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to RN Utilization Review Clinician - Prior Authorization Expert. Be the first to apply!


