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
- ...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 workMedicalShift work
- ...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 jobMedical
- ...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 workMedical
- ...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 workMedicalWork at officeMonday to Friday
- 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 workMedicalFlexible hoursShift work
- ...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 workMedicalFull timePart timeWork at officeLocal areaWork from homeMonday to FridayFlexible hoursWeekend work
- ...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 workMedical
- ...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 workMedicalFull time
$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 workMedicalFull timeTemporary workWork from homeMonday to Friday- ...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 jobMedical
- 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 jobMedical
$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 workMedicalHourly payFull timeTemporary workWork experience placementWork at officeLocal areaWork from home$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 workMedicalHourly payFull timeTemporary workWork experience placementWork at officeLocal areaWork from home$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 workMedicalHourly payMinimum wageFull timeWork experience placementLocal area$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 workMedicalHourly payFull timeTemporary workLocal areaMonday to FridayFlexible hoursShift work$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 workMedicalNight shift- ...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 workMedicalFull timeDay shift
- ...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 workMedicalFull timePart timeWork at officeLocal areaShift workDay shift
$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 workMedicalFull timeWork at officeFlexible hoursWeekend work- ...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 workMedicalContract work
$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 workMedicalTemporary work$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 workMedicalFull time- ...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 workMedical
- ...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 workMedical
$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 workMedicalHourly payContract workTemporary workPart timeFor contractorsWork at officeShift workDay shift- 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 workMedical
- ...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 workMedical
- ...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 workMedical
- ...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 workMedical
- ...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 workMedicalContract work
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