Sign up to access all features of our service.
  • Job search
  • Favorites
  • Create a CV
    New
  • Salaries
  • Subscriptions

RN Utilization Review Clinician - Prior Authorization Expert

$26.41 - $61.79 per hour

Molina 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

Vacancy posted 4 days ago
Similar jobs that could be interesting for youBased on the RN Utilization Review Clinician - Prior Authorization Expert in New York, NY vacancy
  • $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... 
    Suggested
    Hourly pay
    Work experience placement
    Live in
    Work at office

    Molina Healthcare

    New York, NY
    4 days ago
  • 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... 
    Suggested
    Remote job
    Flexible hours
    Weekend work
    Weekday work

    Santa Barbara Cottage Hospital

    New York, NY
    2 days ago
  •  ...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

    Dane Street, LLC

    New York, NY
    2 days ago
  • $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... 
    Suggested
    Remote job
    Hourly pay

    Oscar Health

    New York, NY
    2 days ago
  • $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... 
    Suggested
    Remote job
    Full time
    Monday to Friday

    Broadway Ventures LLC

    New York, NY
    2 days ago
  • $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 work
    Remote work
    Weekend work

    IntePros

    New York, NY
    2 days ago
  • 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

    Appworkshub

    New York, NY
    2 days ago
  • $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 job
    Hourly pay
    Flexible hours

    Cohere Health

    New York, NY
    2 days ago
  • $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 job
    Relief
    Flexible hours

    Acentra Health, LLC

    New York, NY
    1 day ago
  •  ...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

    Martin's Point Health Care Inc.

    New York, NY
    4 days ago
  • 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 job
    Work at office
    Flexible hours

    Martin's Point Health Care Inc.

    New York, NY
    4 days ago
  • $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 pay
    Contract work
    Summer work
    Remote work

    Mercor

    New York, NY
    16 days ago
  • 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 LLC
    Remote job

    Broadway Ventures LLC

    New York, NY
    1 day ago
  •  ...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 office
    Remote work

    Santa Barbara Cottage Hospital

    New York, NY
    2 days ago
  •  ...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 time
    Temporary work
    Part time
    Work at office
    Local area
    Immediate start
    Flexible hours
    Night shift

    Capital Health

    New York, NY
    19 hours ago
  •  ...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 job
    Full time

    Molina Healthcare, Inc.

    New York, NY
    3 days ago
  • ## 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 time
    Temporary work
    Part time
    Flexible hours

    Capital Health

    New York, NY
    1 day ago
  •  ...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 office
    Remote work
    Monday to Friday
    Flexible hours

    6AM City, LLC

    New York, NY
    3 days ago
  • 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

    Freelanceshop

    New York, NY
    9 hours ago
  •  ...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 job
    Local area
    Monday to Friday
    Shift work

    Santa Barbara Cottage Hospital

    New York, NY
    2 days ago
  •  ...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... 

    Phoebe Putney Memorial Hospital, Inc.

    New York, NY
    3 days ago
  • 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... 

    Capital Health

    New York, NY
    1 day ago
  •  ...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... 

    The Ohio State University Wexner Medical Center

    Brooklyn, NY
    3 days ago
  • $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 work
    Summer work
    Remote work

    Mercor

    New York, NY
    16 days ago
  •  ...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 time
    Work experience placement
    Work at office
    Local area
    Immediate start
    Night shift

    OSS Health

    New York, NY
    3 days ago
  • $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 job
    Hourly pay
    Weekly pay
    Job sharing
    Contract work
    Part time
    For contractors
    Flexible hours

    24-MAG

    New York, NY
    3 days ago
  •  ...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 pay
    Contract work
    Work at office
    Local area
    Immediate start
    Flexible hours

    One Brooklyn Health

    Brooklyn, NY
    5 days ago
  •  ...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 office
    Immediate start

    One Brooklyn Health System, Inc.

    Brooklyn, NY
    1 day ago
  • $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 job
    Immediate start
    Monday to Friday

    Alignment Healthcare LLC

    New York, NY
    10 hours ago
  •  ...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 time
    Work from home

    VIllageCare of New York

    New York, NY
    20 hours ago

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!