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

Remote Nurse: Medical Necessity Review & Authorization

HealthHelp

HealthHelp, a WNS company, seeks a Clinical Review Nurse for a fully remote role in the United States. You will perform prospective reviews for medical necessity on prior authorization requests across multiple specialty programs and refer non-qualifying cases to Physician Reviewers. You will operate in a production setting with daily case targets and QA audits, receiving structured training before ramping up to full production with coaching and ongoing support. #J-18808-Ljbffr

Vacancy posted 16 hours ago
Similar jobs that could be interesting for youBased on the Remote Nurse: Medical Necessity Review & Authorization in United States vacancy
  •  ...Technologies, Inc. is seeking a Clinical Review Nurse - Prior Authorization for a 12-month assignment. The role is remote (PST/CST) with scheduling across multiple...  ...requirements. You will review PA requests for medical necessity, assess complex cases, and guide the... 
    Remote work
    Medical
    Shift work

    Spectraforce Technologies

    United States
    15 hours ago
  •  ...Health Plan in California seeks an LVN-validated Claims Review Nurse to audit medical necessity across inpatient and outpatient claims and support the...  ...Claims interface. You will analyze records, determine authorization needs, and collaborate with physicians and staff to... 
    Remote job
    Medical

    Inland Empire Health Plan

    Rancho Cucamonga, CA
    3 days ago
  •  ...Technologies, Inc. is seeking a Clinical Review Nurse - Prior Authorization to perform clinical reviews of...  ...documentation, determining medical necessity, requesting information, documenting...  ...meeting turnaround times. This is a remote role with a 12-month duration and potential... 
    Remote work
    Medical

    Spectraforce Technologies

    United States
    2 days ago
  •  ...Position Title Clinical Review Nurse - Prior Authorization Work Location Remote; nationally sourced within approved U.S. states. Must be available...  ...submitted clinical documentation, determining medical necessity within scope, requesting additional information... 
    Remote work
    Medical
    Work at office
    Monday to Friday

    Spectraforce Technologies

    Jacksonville, FL
    3 days ago
  • Position Title Clinical Review Nurse - Prior Authorization Work Location Remote - PST and CST (No CA and NY candidates please) Assignment Duration 12 Months...  ...prior authorization requests to determine medical necessity of service and appropriate level of care in accordance... 
    Remote work
    Medical
    Flexible hours
    Shift work

    Spectraforce Technologies, Inc.

    Houston, TX
    1 day ago
  •  ...Analyzes all prior authorization requests to determine medical necessity of service and appropriate...  ...the flexibility to work remotely from their home anywhere...  ...necessity and clinical reviews of authorization...  ...an Accredited School of Nursing or Bachelor’s degree in... 
    Remote work
    Medical
    Full time
    Part time
    Work at office
    Local area
    Work from home
    Monday to Friday
    Flexible hours
    Weekend work

    Centene Corporation

    Topeka, KS
    4 days ago
  •  ...Spectraforce Technologies is seeking a Clinical Review Nurse - Prior Authorization for a 6-month assignment, with potential to extend or convert...  ...support the Centralized Transplant Unit by performing medical necessity reviews and consolidating clinical information into... 
    Remote work
    Medical

    Spectraforce Technologies

    Raleigh, NC
    2 days ago
  •  ...Corporation in the United States is seeking a Nursing professional to analyze prior authorization requests and determine medical necessity and level of care in line with standards...  ...preferred. This role offers full-time remote-friendly scheduling with occasional weekend... 
    Remote work
    Medical
    Full time

    Centene Corporation

    United States
    1 hour ago
  • $71.1k - $97.8k

     ...a Behavioral Health Prior Authorization Nurse to join the Wisconsin Medicaid...  ...team. This role involves reviewing the clinical...  ...requests to ensure they meet medical necessity and other criteria. Highlights...  ...- $97,800/year Location: Remote, WI Schedule: Full-time, Monday... 
    Remote work
    Medical
    Full time
    Temporary work
    Work from home
    Monday to Friday

    Humana

    Madison, WI
    16 hours ago
  •  ...experienced LPN/LVN to support utilization review in a managed care UM program. You...  ...pre/post service reviews, determine medical necessity, and authorize eligible requests. Collaborate with...  ...appeals within NCQA-aligned guidelines. Remote opportunities across the US are... 
    Remote job
    Medical

    Integra Partners

    Brooklyn, NY
    2 days ago
  • Ensemble Health Partners is seeking a Virtual Utilization Review Specialist to join our remote team. You will perform medical necessity reviews, manage denials, and coordinate with FCC and care management to optimize patient care while controlling costs. Qualified candidates... 
    Remote job
    Medical

    Ensemble Health Partners

    New York, NY
    13 hours ago
  • $26.01 - $56.14 per hour

     ...Utilization Management Nurse Consultant (RN) Remote | Concurrent Review | Utilization Management...  ...utilization management or prior authorization experience looking to make...  ...across a broad range of medical specialties Evaluate medical necessity using clinical records, evidence... 
    Remote work
    Medical
    Hourly pay
    Full time
    Temporary work
    Work experience placement
    Work at office
    Local area
    Work from home

    4004 Aetna Medicaid Administrators

    Louisiana, MO
    5 days ago
  • $26.01 - $56.14 per hour

     ...a time. Utilization Management Nurse Consultant (RN) – Concurrent Review Remote | Acute Inpatient Utilization Management...  ...hospital stays Evaluate medical necessity, severity of illness, intensity...  ...and regulatory requirements to authorization decisions Partner with Medical... 
    Remote work
    Medical
    Hourly pay
    Full time
    Temporary work
    Work experience placement
    Work at office
    Local area
    Work from home

    CVS Health

    Austin, TX
    3 days ago
  • $29 - $52 per hour

     ...Secondary Review NurseAt UnitedHealthcare...  ...Secondary Review Nurse plays a critical...  ...care provided is medically necessary, cost-effective...  ...to work remotely as you take on some...  ...and process prior authorization requests for LTSS...  ...medical necessity and appropriateness... 
    Remote work
    Medical
    Hourly pay
    Minimum wage
    Full time
    Work experience placement
    Local area

    divvyDOSE

    Indianapolis, IN
    3 days ago
  • $26.01 - $56.14 per hour

     ...EST Location: 100% Remote (U.S. only) About...  ...a URAC-accredited medical management organization...  ...Management (UM) Nurse Consultant specializing in Medical Review, you’ll play a...  ...specific criteria to authorize procedures/...  ...determine medical necessity. MCG Milliman,... 
    Remote work
    Medical
    Hourly pay
    Full time
    Temporary work
    Local area
    Monday to Friday
    Flexible hours
    Shift work

    CVS Health

    Kansas City, MO
    2 days ago
  • $69.8k - $125.9k

     ...Management (UM) and Quality Review (QR) functions...  ...years of experience as a Nurse Reviewer or Clinical...  ...determinations, medical necessity reviews, benefit terminations...  .... ~ Strong prior authorization experience within a...  ...This is a remote role Pay Transparency... 
    Remote work
    Medical
    Night shift

    Health Care Service Corporation

    United States
    4 days ago
  •  ...This Role The Secondary Review Nurse plays a critical role...  ...that care is medically necessary, cost-effective...  ...Indiana Work Style: Remote What You'll Do Participate...  ...and process prior authorization requests for LTSS and...  ...to determine medical necessity and appropriateness of... 
    Remote work
    Medical
    Full time
    Day shift

    UnitedHealth Group

    Indianapolis, IN
    1 day ago
  •  ...ShiftDescription: This is a remote position but will...  ...day one (Medical, Dental, Vision,...  ...clinical reviews of patient records...  ...evaluate medical necessity, appropriateness...  ...with physicians, nursing staff, and interdisciplinary...  ...to denials and authorization changes by... 
    Remote work
    Medical
    Full time
    Part time
    Work at office
    Local area
    Shift work
    Day shift

    Saint Alphonsus Health System

    Mishawaka, IN
    4 days ago
  • $70k - $120k

     ...Our company is fully remote and offers a flexible...  ...offers 100% employer paid medical, vision, dental, and...  ...of UM Outpatient Review Nurse reports to the Director...  ...to determine medical necessity. Duties and...  ...responsibilities Review authorization requests for medical... 
    Remote work
    Medical
    Full time
    Work at office
    Flexible hours
    Weekend work

    All Care To You

    Remote
    6 days ago
  •  ...Actalent seeks a Clinical Prior Authorization Reviewer to assess medical necessity and determine the appropriate level of care for requests. You will support...  ...and timely documentation in One Note within a fully remote, contract-based environment across Pacific/central time... 
    Remote work
    Medical
    Contract work

    Actalent

    Portland, OR
    4 days ago
  • $63.9k - $83.08k

     ...Claims Review Nurse, LVNFind joy in serving others with IEHP! We welcome...  ...for conducting timely medical reviews of IEHP facility and...  ...recommendations to improve the claim authorization process and business rules...  ...:Audit medical necessity claims in accordance with departmental... 
    Remote work
    Medical
    Temporary work

    Credenza Health

    Rancho Cucamonga, CA
    5 days ago
  • $26.01 - $56.14 per hour

     ...This Role The Concurrent Review UM Nurse Consultant role at CVS...  ...management or prior authorization. This position focuses...  ...$56.14/hour Location: Remote, LA Residency: Louisiana...  ...across a broad range of medical specialties. Evaluate medical necessity using clinical records,... 
    Remote work
    Medical
    Full time

    CVS Health Corporation

    Louisiana, MO
    2 days ago
  •  ...is seeking a Clinical Pharmacy Reviewer (Pharmacist) to evaluate complex prior authorization requests, appeals, and medication coverage determinations in a remote setting. The role applies evidence...  ...Review (DUR) to ensure medical necessity and regulatory compliance, impacting... 
    Remote work
    Medical

    Dane Street

    New York, NY
    4 days ago
  •  ...CorroHealth Inc is seeking a Remote Clinical Review & Prior Authorization Specialist in the United States. You will perform clinical reviews of PA requests, assess medical necessity, and validate AI-assisted outputs to ensure accurate determinations. You will collaborate... 
    Remote work
    Medical

    CorroHealth Inc

    New York, NY
    13 hours ago
  • $35 per hour

     ...pay range $35.00/hr - $35.00/hr Medical Review Nurse Location: Phoenix, AZ 85034 (Remote) 3+ Months Day Shift Position...  ...reviews and evaluating against prior authorizations and UB claims. If a candidate...  ...emergency criteria, medical necessity, and/or correct revenue code/CPT... 
    Remote work
    Medical
    Hourly pay
    Contract work
    Temporary work
    Part time
    For contractors
    Work at office
    Shift work
    Day shift

    Axius Technologies Inc.

    Phoenix, AZ
    3 days ago
  • The Behavioral Health Prior Authorization Utilization Review Consultant monitors,...  ...approves or denies payment for medical and behavioral healthcare...  ...The role determines medical necessity based on standards of care...  ...located in Phoenix with remote work options available and... 
    Remote work
    Medical

    AHCCCS

    Phoenix, AZ
    3 days ago
  •  ...and post-service utilization reviews and appeals within a NCQA-compliant...  ..., collaborating with our Medical Director. The role...  ...and CMS to determine medical necessity, with responsibilities including...  ...referrals, and handling appeals. Remote opportunities available and... 
    Remote work
    Medical

    Integra Partners

    United States
    16 hours ago
  •  ...service and post-service utilization reviews and appeals for DMEPOS. You will collaborate with our Medical Director to ensure benefit and medical necessity reviews meet NCQA UM standards,...  ...guidelines. The role supports a nationwide remote workforce with competitive... 
    Remote work
    Medical

    Integra Partners

    United States
    2 days ago
  •  ...service requests, verify member benefits, and process prior authorizations. Candidates must have an Illinois state RN license and 1-3 years of experience in hospital or medical clinic settings. This is a fully remote position, offering work within a collaborative... 
    Remote work
    Medical

    Integrated Resources

    United States
    2 days ago
  •  ...seeking a highly motivated Utilization Review RN to join our team. The RN will...  ...outpatient, and ancillary services to ensure medical necessity, appropriate length of stay, and level...  ...and members. Responsibilities include authorizing services, coordinating discharge... 
    Remote work
    Medical
    Contract work

    HealthEdge

    United States
    3 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to Remote Nurse: Medical Necessity Review & Authorization. Be the first to apply!