Remote RN - Medicaid Prior Authorization & Policy Review
Pyramid Consulting, Inc.
- Remote job
Pyramid Consulting, Inc. is hiring a Registered Nurse for a remote US contract role. You will review Medicaid prior authorization requests, apply InterQual criteria, and determine medical necessity while maintaining high productivity. The position requires 3+ years of RN experience, compact license, and strong documentation skills. Collaboration with a remote team and attention to compliance are essential. #J-18808-Ljbffr Pyramid Consulting
- ...license. The Care Review Clinician will provide prior authorization for behavioral health... ...for the OH Medicaid population. Strong... ...schedule. This is a remote position. Home office... ...guidelines, insurance policies, and regulations -... ...Registered Nurse (RN). License must be active...Remote workPolicyWork at officeHome officeMonday to Friday
$23.76 - $51.49 per hour
...license. The Care Review Clinician will provide prior authorization for behavioral health... ...for the OH Medicaid population. Strong... ...schedule. This is a remote position. Home office... ...guidelines, insurance policies, and regulations -... ...Registered Nurse (RN). License must be active...Remote workPolicyHourly payWork experience placementWork at officeHome officeMonday to Friday$78k - $85k
Overview Medicaid Medical Review RN (Medical Reviewer III) - REMOTE The Medicaid Medical Review RN (Medical Reviewer III) will primarily be responsible for conducting... ...vulnerabilities in Medicare or Medicaid payment policies Utilizes extensive knowledge of medical...Remote workPolicyFor contractorsH2bH1bWork at officeLocal areaHome office- ...DescriptionLocation: Fully remote. Candidates must be able... ...experienced Concurrent Review Registered Nurse (RN) to join its Utilization... ...perform concurrent reviews, prior authorizations, medical necessity... ...on utilization management policies and review criteria.Document...Remote workPolicyWork at officeImmediate start
- ...Description Utilization Review Nurse Location:... ...[City, State / Remote] Employment... ...Nurse (RN) with experience... ...payers regarding authorization and coverage determinations... ...CMS, Medicare, Medicaid, Joint... ..., payer policies, and evidence-based... ...methodologies and prior authorization...Remote workPolicyFull timeSecond jobWork at office
- ...Job Title: Clinical Review Nurse - Concurrent... ...letters for Texas Medicaid behavioral health codes requiring prior authorization. Review behavioral... ...established policies and procedures. Collaborate... ...Information Remote position. Monday–Friday... ...license as an RN, LPN, or LVN. At least...Remote workPolicyFull timeMonday to FridayShift work
- ...Medical Management for Medicare and/or Medicaid populations. 2. Utilization... ...build and implements care management review processes (Prior Authorization, Predetermination, Concurrent Reviews... ...as other clinical guidelines and policies. 3. Ensures that interventions are...Remote workPolicyCasual workWork at officeShift work
$35 - $40 per hour
...and analytics. Job Title RN Utilization Management Reviewer Responsibilities Conduct... ...review for services requiring prior authorization in a variety of clinical... ...consistency in applying policy. Collaborate with UM... ...weekends. Location: Fully remote work at home role. Secure...Remote workPolicyHourly payTemporary workMonday to FridayFlexible hoursWeekend work$95k - $107.5k
...Title: Nurse Reviewer, Utilization Management... ...MA office; 1 day remote FLSA Status:... ...requirements to authorization requests, coordinates... .../DHA coverage policy. Review prior authorization and... ...in Nursing (ADN/RN) required; Bachelor... ...Advantage, or Medicaid managed care organization...Remote workPolicyFull timeLocal area$64.48k - $72.8k
...Opportunity Overview: The Clinical Review & Correspondence RN plays a critical role in... ...about this role: This is a 100% remote role, and requires robust internet... ...across the care continuum–including policy, prior authorization, payment accuracy, and more–the company...Remote workPolicyFull timeFlexible hoursShift work$27.02 - $48.55 per hour
...: Analyzes all prior authorization requests to determine... ...: This fully remote role requires an active New York RN license and the... ...necessity and clinical reviews of authorization... ...Complies with all policies and standards... ...Knowledge of Medicare and Medicaid regulations...Remote workPolicyHourly payFull timePart timeWork at officeMonday to FridayFlexible hours- ...oriented Registered Nurse (RN) to join a specialized... ...be responsible for reviewing and evaluating critical... ...accordance with established policies and timeframes. This... ...technology to support remote and hybrid work... ...community-based services, Medicaid waivers, and care coordination...Remote workPolicyWork from home
- ...Capgemini, is seeking a Clinical Review Nurse for a fully remote, full-time role. You will... ...clinical guidelines and policies to decide medical necessity.... ...oversight. The role requires an RN or LPN license, at least two years of prior authorization review experience, and...Remote workPolicyFull time
- ...Management Location: 100% Remote Schedule: M-F 9:00am... ...an Illinois state RN license Assess and analyze... ...eligibility Process prior authorization determinations within... ...necessity/utilization review and other utilization... ...) according to Client policy for Client members as...Remote workPolicyContract work
$39 - $40 per hour
...Job Position: Concurrent Review RN Location: Chicago, IL 60601... ...candidates note that this role is remote. Required Education and... ...as Knowledge of Medicare and Medicaid regulations; Knowledge of utilization... ...criteria/guidelines, and policy, including insurance...Remote workPolicyLocal area$34 - $47 per hour
...UM Review NurseAstrana Health is looking for a CA-... ...Health Plans. This is a remote position for CA-... ...TeamWhat You'll Do:Complete prior authorization/retrospective review... ...standardsComply with internal policies and proceduresPerform... ...unrestricted LVN or RN license in California,...Remote workPolicyHourly payLive inWork at officeMonday to FridayShift work$35 - $45 per hour
...IntePros IntePros is seeking a Remote Utilization Review Nurse serves as a key... ...Functions Process patient prior authorization and reauthorization requests... ...accordance with company policies. Review provider documentation... ...nursing program (RN, LPN, or LVN). Minimum of...Remote workPolicyContract workWeekend work- ...Position Title: Clinical Review Nurse - Prior Authorization Work Location: Remote - PST and CST-(No CA and NY candidates please... ...) / Preferred: NV or Compact RN license Assignment Duration: 1... ...knowledge of Utilization Management (policies/regulations), at least 1...Remote workPolicyFlexible hoursShift workWeekend work
$34 - $40 per hour
...00/hr - $40.00/hr Remote (Compact Licensure... ...- Open to LPN's & RN's About the Role Medix... ...Utilization Review Nurse to support our... ...and review patient authorizations, ensure compliance... ...You’ll Do Process prior authorization and... ...line with company policy. Review provider documentation...Remote workPolicyFull time$93.18k - $136.95k
...to hire a Utilization Review Nurse. The Utilization... ...primary functions of prior authorization, retrospective review,... ...criteria, medical policy, and member eligibility... ...Utilization Review Nurse, RN, Care Coordination, or... ...-free environment. Remote Work Sentara Health...Remote workPolicyFull timeTemporary workShift work- ...Description Utilization Review Nurse / Clinical... ...Medical Necessity Reviewer (RN) (MUST LIVE IN NY,... ...compliance with VCMAX policies, while actively... ...understanding of Medicare and/or Medicaid guidelines, coverage... ...precertification/prior authorizations . For California...Remote jobPolicyFull timeLive inWork at officeLocal area
- ...Position Title Clinical Review Nurse - Prior Authorization Work Location Remote; nationally sourced within approved U.S. states. Must be available during... ...benefits, regulatory requirements, and internal policies. Responsibilities include reviewing submitted...Remote workPolicyWork at officeMonday to Friday
- ...Personal Care (SDPC) RN. This is a remote position, where you... ...Wisconsin IRIS program – a Medicaid long-term care... ...of Health Services policies and by completing oversight... ...are obtained and reviews and revises plan of... ...Submits for Prior Authorization for personal care services...Remote workPolicyFull timeWork at office
- ...Description Join our team as a remote (Oklahoma City) full time... ...and every other weekend RN Case Manager -Utilization Review at INTEGRIS Health,... ...accordance with hospital policies and all-applicable state and... ...CMS regulations, Medicare/Medicaid, managed care and other payer...Remote workPolicyFull timeWork at officeWeekend work
- ...Following Programs Medicaid State of Texas... ...concurrent and discharge reviews on assigned patients... ..., and company policies. Provides timely responses... ...contract status prior to processing authorization requests. Complies with... ...Work Schedule: Remote Other Requirements...Remote workPolicyContract workWork experience placement
- ...DescriptionCLINICAL REVIEW NURSE - REMOTE ARC Group has multiple... ...have PERMANENT US work authorization. Sorry, but we are... ...meeting national and local policies as well as accepted... ...cases requiring prior authorization, complex... ...unrestricted Registered Nurse (RN) licensePREFERRED...Remote workPolicyPermanent employmentWork at officeLocal area
$65k - $75k
...Clinical ReviewThe Clinical Review Nurse makes... ...necessity determinations on prior authorization requests for... ...is a full-time, fully remote, production-based role... ...guidelines, client medical policies, and applicable state... ...REQUIREDGraduate of an accredited RN or LPN/LVN nursing...Remote workPolicyHourly payFull timeWork at officeLocal areaMonday to Friday$30 - $40 per hour
...Utilization Review Nurse Astrana Health is looking for a Utilization... ...What You'll Do Complete prior authorization/retrospective review of... ...Comply with internal policies and procedures Perform any... ...Conditions This is a fully remote position. Nurses must be licensed...Remote workPolicyHourly payMonday to FridayShift work- ...Nurse Reviewer II Under the general supervision... ...for the authorization, coordination and... ...established departmental policies, procedures and... ...Qualifications ~ RN licensed to practice... ...Experience with prior authorization and/... ...Coordinator None Remote/desk work with...Remote workPolicyWork experience placementWork at office
$43 per hour
...Description Clinical Review Nurse (RN) | MDS, Quality & Incident... ...4:30 PM Location: Remote/Hybrid with occasional... ...program regulations, policies, and established... ...initiatives CMS or Medicaid program knowledge Required... ...supports programs. Prior experience reviewing...Remote workPolicyWork at officeMonday to Friday
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