Remote RN: Prior Authorization & Utilization Review
IntelliResume
Humana is seeking a Pre-Authorization Registered Nurse for a remote, full-time role based in Virginia. The RN will review prior authorization requests, determine appropriate care settings, and educate providers on utilization and management processes.
Requirements include an active RN license in VA or an eNLC-participating state, plus at least two years of varied clinical nursing experience in acute, skilled, or rehabilitation settings. Compensation aligns with market ranges.
#J-18808-Ljbffr- ...Humana seeks a Pre-Authorization Nurse to review prior authorization requests for appropriate... ...-making abilities. Remote position from LA with a... ...Thurs), 8-hour shifts. Active RN license in Louisiana and 2... ...required; health plan or utilization management background is a...Remote workShift work
$1,949.74 per month
...Nurse Specialty Utilization Review Job ID 17979666... ...Title Utilization Review RN Weekly Pay $1949... ...Job Description Remote Utilization Review RN responsible... ...necessity determinations, prior authorizations, continued stay reviews,...Remote workWeekly payShift work- ...Pride Health is seeking an experienced Registered Nurse (RN) with Utilization Management experience to support clinical quality review and AI model development for prior authorization use cases. The ideal candidate will review records, apply InterQual/MCG criteria, and...Remote work
$26.41 - $51.49 per hour
...complact license. The Care Review Clinician will provide prior authorization for behavioral health... ...experience with Utilization Reviews. WORK SCHEDULE... ...schedule. This is a remote position. Home office with... ...experience. Registered Nurse (RN). License must be active...Remote workHourly payWork experience placementWork at officeHome officeMonday to Friday- ...by Specialty Pediatrics* ICU MS Case Management/Utilization Review Pre-Cert Review* Prior Authorizations* Retrospective Review* Admission Criteria Care... ...Measure/National Safety Goals Additional Skills Remote UR work CA and Medi-Cal experience/knowledge*...Remote work
- ...Management Location: 100% Remote Schedule: M-F 9:00am... ...an Illinois state RN license Assess and analyze... ...eligibility Process prior authorization determinations within... ...Summary Works with the Utilization Management team primarily... ...necessity/utilization review and other utilization...Remote workContract work
$65k - $78k
...Utilization Review Nurse- Remote job at Gainwell Technologies LLC. North Carolina. It takes great medical... ...Review Nurse to conduct prior authorization, prospective, concurrent, and retrospective... ...clinical guidelines. Maintain RN license and meet continuing education...Remote workFull timeContract workWork at officeWork from homeFlexible hours- ...Overview Title: Clinical Review Nurse – Prior Authorization Review Location: Fully Remote (PST Time Zone - WA/OR Resident... ...Authorization Review to join our Utilization Management team. In this role,... ...Qualifications ~ Active RN license (WA; must be in good standing...Remote workContract work
- ...Utilization Review Nurse Location: [City, State / Remote] Employment Type: Full-Time Experience... ...Registered Nurse (RN) with experience in... ...party payers regarding authorization and coverage determinations... ...methodologies and prior authorization processes...Remote workFull timeSecond jobWork at office
- ...Utilization Review Nurse This position has a remote option for those living close and will be able to come into the... ...Others, or Leader of Leaders. The prior authorization role completes an assessment of... ...or compact required RN license in state of employment or...Remote workFull time
$35 - $40 per hour
...$40.00/hr Location Fully Remote Position Summary The Utilization Review Nurse serves as a key liaison in... ...Responsibilities Review and process prior authorizations and reauthorization requests in... ..., active nursing license (RN, LPN, or LVN) in good standing with...Remote workContract workFlexible hoursWeekend work- ...Utilization Review Nurse Join our team at Cobalt Benefits Group and start... ...timely and effective care authorizations, transitions, and utilization... ...reviews for services requiring prior authorization, applying... ...Current, unrestricted RN license (State license required...Remote workFull timeTemporary workSummer workWork at officeFlexible hours
$45 - $51 per hour
...Position Details Position: RN Utilization Management / Utilization Review Setting: 100% Remote Schedule: 5x8-hour days Hours: 8... ...utilization of healthcare resources. Manage prior authorization and pre-certification activities when applicable...Remote workHourly payWeekend work$35 - $40 per hour
...experienced Registered Nurse (RN) with health plan or payer-side Utilization Management (UM) experience... ...support clinical quality review and AI model development for prior authorization use cases. The ideal... ...Fri, 40 hrs/week Fully Remote Position Pay Range: $35...Remote workHourly payLocal areaShift work- ...Job Description: Ascension Texas Utilization Management Department (Fully Remote)Job Summary:• Provides health care services regarding admissions, case management, discharge planning and utilization review.Responsibilities:• Reviews admissions and service requests within...Remote work
- ...Job Title In this remote role, you will perform utilization reviews, ensuring compliance with clinical guidelines and patient care standards. Collaborate with interdisciplinary teams to assess patient needs and facilitate care coordination. Your expertise in medical...Remote workWeekly pay
- ...Comagine Health is seeking Clinical Utilization Review Nurses (RN) licensed in Alabama for a remote, full-time role. You will assess medical necessity and quality of healthcare services through prospective, concurrent, and retrospective reviews to support compliant, cost...Remote workFull time
- ...BJC HealthCare seeks a PRN Utilization Review RN to support hospital resource utilization from a remote location within one hour of St. Louis, MO. You will review admissions for medical necessity and educate providers on appropriate care levels. Two years UR experience...Remote workFull timeReliefShift work
- ...United States is seeking an Inpatient Utilization Management Clinician to evaluate... ...across care teams. This fully remote, full-time role requires an active RN license, nursing degree, and experience... ...care management to ensure timely reviews, document outcomes, and maintain...Remote workFull time
- ...BJC HealthCare is seeking a registered nurse to join a remote Utilization Review team. The role supports multiple hospital units with no patient communication, and it is designed for local remote work with weekend rotation. Responsibilities include applying Interqual criteria...Remote workLocal areaWeekend work
$30 - $38 per hour
...A healthcare organization is seeking a part-time Utilization Review Nurse RN to conduct assessments and reviews for medical necessity of treatment requests. This role involves working 28 hours per week with responsibilities such as providing reviews for pre-certification...Remote workHourly payPart time- ...Providing timely and evidence-based utilization review services, the full-time Utilization Review RN will work remotely to manage complex medical conditions, treatment planning, and recovery for injured employees while advocating for effective medical treatment. Key responsibilities...Remote workFull timeWork experience placement
- ...WNS, part of Capgemini, seeks a remote Utilization Review Nurse to perform medical necessity reviews and collaborate with providers to ensure compliant... ...team-oriented environment. Requirements include active RN or LVN licensure, a minimum of two years in utilization...Remote workWork at office
$72.8k - $130k
...occasional opportunity for remote work based on... .... As a Sr Utilization Management Nurse... ...discuss care details, reviewing clinical... ...review of current and prior patient conditions... ...Registered Nurse (RN) with a current, active... ..., including prior authorization, concurrent...Remote workMinimum wageFull timeWork experience placementCasual workLive inWork at officeLocal area- ...Job Details POSITION SUMMARY - RN Utilization Review POSITION DUTIES - Review patient medical records to assess the appropriateness... ...experience (hospital-based) ~ Skilled experience with remote work LENGTH OF ASSIGNMENT - 13 weeks...Remote workTemporary workShift workWeekend work
- ...Centene Corporation is seeking a remotely based Registered Nurse to perform concurrent reviews, assess acuity, and validate medical necessity across care settings... ...findings, assisting with discharge planning, and educating providers on utilization #J-18808-LjbffrRemote work
- ...OpTech is seeking a Registered Nurse (RN) to support utilization review and clinical review activities for a Michigan health plan. This role involves... ...are encouraged to apply. The position offers flexible/remote work options and competitive pay. #J-18808-LjbffrRemote workFlexible hours
$2,158.8 per week
...Ref. 65547807 RN - Utilization Review $2,158.80 per week Location: Fort... ...assignment in Fort Myers, FL. This remote position requires expertise in utilization... ...or 5 years of experience ~ Prior travel experience highly preferred...Remote workWeekly payWork experience placementMonday to FridayFlexible hoursShift workWeekend work$38.66 - $58.32 per hour
...Summary and Responsibilities As our Utilization Review RN, you will meticulously review medical... ..., and obtaining inpatient authorization from insurance providers, ensuring seamless... ...status. This position is open to remote/out of state candidates residing in only...Remote work$2,023.3 per month
...Nursing Profession Registered Nurse (RN) Specialty Utilization Review Job ID 38245223 Job Title Registered... ...Must be computer literate and have some experience with remote work. Responsibilities Utilize clinical...Remote workWeekly payContract workLocal areaMonday to FridayShift workWeekend work
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