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Remote Prior Authorization Nurse Jobs in Appleton, WI

State of Wisconsin

Licensed Practical Nurse

Green Bay, WI · On-site +1

$38.59/hr

Job Details Applicants must be legally authorized to work in the United States (i.e. a citizen or ... This position is not eligible for remote work. Shifts: (0.75 FTE) Dodge Correctional Institution ...

State of Wisconsin

Nurse Clinician 4 90%

Oshkosh, WI · On-site +1

$48.70 - $57.23/hr

Job Details This position is not eligible for remote work and will work on site. Anticipated ... Applicants must be legally authorized to work in the United States (i.e., a citizen or national of ...

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Remote Prior Authorization Nurse information

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$16

$37

$63

How much do remote prior authorization nurse jobs pay per hour?

As of Aug 30, 2026, the average hourly pay for remote prior authorization nurse in Appleton, WI is $37.68, according to ZipRecruiter salary data. Most workers in this role earn between $28.85 and $42.21 per hour, depending on experience, location, and employer.

What is a remote prior authorization nurse?

A Remote Prior Authorization Nurse is a registered nurse (RN) or licensed practical nurse (LPN) who reviews medical insurance requests to determine if they meet coverage criteria. They work remotely to assess patient records, collaborate with healthcare providers, and communicate approval or denial decisions based on insurance guidelines. Their role helps ensure patients receive necessary treatments while managing costs for insurance companies. Strong clinical knowledge, attention to detail, and familiarity with insurance policies are essential for this position.

What does a remote prior authorization nurse do?

A typical day for a Remote Prior Authorization Nurse involves reviewing medical records and provider documentation, communicating with physicians or healthcare providers to gather additional information, and submitting authorizations to insurance companies. You may spend much of your time using specialized software to track requests, document outcomes, and ensure compliance with payer guidelines. Collaboration is often required with case managers, providers, and insurance representatives to resolve questions and expedite approvals. While the work is primarily independent, staying organized and communicating effectively with the healthcare team are essential for success in this remote position.

What are the key skills and qualifications needed to thrive as a remote prior authorization nurse?

To thrive as a Remote Prior Authorization Nurse, you need a current RN license, knowledge of medical terminology, and experience with insurance or utilization review processes. Familiarity with prior authorization software, electronic medical records (EMRs), and payer systems is typically required, along with certifications like CCM or CPUR as a plus. Strong attention to detail, organizational skills, and effective written communication are valuable soft skills for this role. These skills are crucial to ensure accurate and efficient authorization of healthcare services, reduce claim denials, and facilitate patient care in a remote setting.

What are popular job titles related to Remote Prior Authorization Nurse jobs in Appleton, WI?

For Remote Prior Authorization Nurse jobs in Appleton, WI, the most frequently searched job titles are:

What job categories do people searching Remote Prior Authorization Nurse jobs in Appleton, WI look for?

The top searched job categories for Remote Prior Authorization Nurse jobs in Appleton, WI are:

What cities near Appleton, WI are hiring for Remote Prior Authorization Nurse jobs?

Cities near Appleton, WI with the most Remote Prior Authorization Nurse job openings:

Remote Prior Authorization Nurse jobs near you
Infographic showing various Remote Prior Authorization Nurse job openings in Appleton, WI as of August 2026, with employment types broken down into 74% Full Time, 13% Temporary, and 13% Contract. Highlights an 100% Remote job distribution, with an average salary of $78,372 per year, or $37.7 per hour.

RN Coordinator Utilization Management

Menasha, WI • On-site, Remote

Network Health WI
Insurance Services • 201 - 500 employees

7.9

Company rating: 7.9 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

187th of 315 rated insurance

People enjoy working here

Good employer

Respectful managers

Learn more about Network Health WIexternal

Full-time

Re-posted 24 days ago

Job description

The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable guidelines regarding payment and coverage, and makes determinations for authorization/payment.
Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required). Travel to the corporate office in Menasha is required occasionally for the position, including on first day. Training is required in person at our Menasha location for the first 6-8 weeks.
Hours: 1.0 FTE, 40 hours per week, 8am - 5pm Monday through Friday
Check out our 2025 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.
Job Responsibilities:
  • Evaluate and process prior authorization requests/referrals submitted from contracted and non-contracted providers
  • Follow Network Health process, policies, and procedures in authorization review of all membership on a pre-service, concurrent and post-service basis. This process includes verifying eligibility and benefits, as well as documenting all utilization management communication
  • Provide education regarding utilization management activities and processes to members, caregivers, providers, and their administrative staff
  • Participate in Utilization Management auditing (i.e. Utilization Management Inter-reviewer reliability and denial files)
  • Refer all members with complex health problems and needs to Network Health Case Management to reduce medical costs while providing a higher quality of life and an ability to take charge of their diseases. This requires an extensive holistic approach to care management assessment
  • Collaborate with other NH departments to develop interdepartmental operational processes
  • Support Utilization Management department programs and goals through active participation
  • Identify and screen candidates for Case Management intervention and determines appropriate level of care from Utilization Management criteria
  • Complete assessments and plans of care including need for medication regime, treatment plans, practitioner follow-up appointments, knowledge of red flags, disease management, Advance Directives, life planning, and self-management of illness to the best of member ability
  • Evaluate cases for cost savings/quality improvement potential
  • Other duties and responsibilities as assigned

Job Requirements:
  • Bachelor of Science in Nursing, preferred
  • Associate Degree in Nursing, required
  • Current registered nurse licensure in Wisconsin required
  • Minimum of four (4) years clinical health care experience as a Registered Nurse (RN) required
  • Experience in insurance, managed care and utilization management preferred

Network Health is an Equal Opportunity Employer
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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