Ability to work independently in a remote environment * Proficiency with EMR systems preferred ... Process prior authorizations and continued stay reviews * Document all review decisions accurately ...
Ability to work independently in a remote environment * Proficiency with EMR systems preferred ... Process prior authorizations and continued stay reviews * Document all review decisions accurately ...
Ability to work independently in a remote environment * Proficiency with EMR systems preferred ... Process prior authorizations and continued stay reviews * Document all review decisions accurately ...
Quick apply
Ability to work independently in a remote environment * Proficiency with EMR systems preferred ... Process prior authorizations and continued stay reviews * Document all review decisions accurately ...
Ability to work independently in a remote environment * Proficiency with EMR systems preferred ... Process prior authorizations and continued stay reviews * Document all review decisions accurately ...
Ability to work independently in a remote environment * Proficiency with EMR systems preferred ... Process prior authorizations and continued stay reviews * Document all review decisions accurately ...
Care Review Clinician (RN)
Long Beach, CA · On-site +1
$23.76 - $51.49/hr
... prior authorization/financial responsibility for Molina and its members. • Processes requests ... • Registered Nurse (RN). License must be active and unrestricted in state of practice. • ...
Care Review Clinician (RN)
Long Beach, CA · On-site +1
$23.76 - $51.49/hr
... prior authorization/financial responsibility for Molina and its members. • Processes requests ... • Registered Nurse (RN). License must be active and unrestricted in state of practice. • ...
Care Review Clinician (RN)
Long Beach, CA · On-site +1
$23.76 - $51.49/hr
... prior authorization/financial responsibility for Molina and its members. • Processes requests ... • Registered Nurse (RN). License must be active and unrestricted in state of practice. • ...
Care Review Clinician (RN)
Long Beach, CA · On-site +1
$23.76 - $51.49/hr
... prior authorization/financial responsibility for Molina and its members. • Processes requests ... • Registered Nurse (RN). License must be active and unrestricted in state of practice. • ...
Care Review Clinician (RN) Weekends
Long Beach, CA · On-site +1
$23.76 - $51.49/hr
... prior authorization/financial responsibility for Molina and its members. • Processes requests ... • Registered Nurse (RN). License must be active and unrestricted in state of practice. • ...
Care Review Clinician (RN) Weekends
Long Beach, CA · On-site +1
$23.76 - $51.49/hr
... prior authorization/financial responsibility for Molina and its members. • Processes requests ... • Registered Nurse (RN). License must be active and unrestricted in state of practice. • ...
Utilization Review Clinician (RN) - Must live in NY
Long Beach, CA · On-site +1
$26.41 - $61.79/hr
... prior authorization/financial responsibility for Molina and its members. • Processes requests ... • Registered Nurse (RN). License must be active and unrestricted in state of practice. • ...
Utilization Review Clinician (RN) - Must live in NY
Long Beach, CA · On-site +1
$26.41 - $61.79/hr
... prior authorization/financial responsibility for Molina and its members. • Processes requests ... • Registered Nurse (RN). License must be active and unrestricted in state of practice. • ...
Utilization Management Nurse I, RN
Huntington Beach, CA · Remote
$34.98 - $42.85/hr
Functions & Job Responsibilities · Conduct clinical review of prior authorization requests using ... Remote
Utilization Management Nurse I, RN
Huntington Beach, CA · Remote
$34.98 - $42.85/hr
Functions & Job Responsibilities · Conduct clinical review of prior authorization requests using ... Remote
Episodic Case Manager LVN
Sherman Oaks, CA · Remote
$35 - $40/hr
The RN/LVN Case Manager acts as patient advocate through the continuum and is available to the ... prior authorization, and other needs. Collaborates with Social Work team to coordinate care and ...
Quick apply
Episodic Case Manager LVN
Sherman Oaks, CA · Remote
$35 - $40/hr
The RN/LVN Case Manager acts as patient advocate through the continuum and is available to the ... prior authorization, and other needs. Collaborates with Social Work team to coordinate care and ...
The RN/LVN Case Manager acts as patient advocate through the continuum and is available to the ... prior authorization, and other needs. Collaborates with Social Work team to coordinate care and ...
The RN/LVN Case Manager acts as patient advocate through the continuum and is available to the ... prior authorization, and other needs. Collaborates with Social Work team to coordinate care and ...
Remote Utilization Review RN - RURR 26-06086
Healdsburg, CA · Remote
$40 - $45/hr
Remote Utilization Review RN Location: Santa Rosa, CA Assignment Duration: 13 Weeks Schedule: Day ... Submit, track, and monitor authorizations, approvals, and denials * Maintain accurate, timely, and ...
Remote Utilization Review RN - RURR 26-06086
Healdsburg, CA · Remote
$40 - $45/hr
Remote Utilization Review RN Location: Santa Rosa, CA Assignment Duration: 13 Weeks Schedule: Day ... Submit, track, and monitor authorizations, approvals, and denials * Maintain accurate, timely, and ...
Remote Utilization Review RN - RURR 26-06086
Rohnert Park, CA · Remote
$40 - $45/hr
Remote Utilization Review RN Location: Santa Rosa, CA Assignment Duration: 13 Weeks Schedule: Day ... Submit, track, and monitor authorizations, approvals, and denials * Maintain accurate, timely, and ...
Remote Utilization Review RN - RURR 26-06086
Rohnert Park, CA · Remote
$40 - $45/hr
Remote Utilization Review RN Location: Santa Rosa, CA Assignment Duration: 13 Weeks Schedule: Day ... Submit, track, and monitor authorizations, approvals, and denials * Maintain accurate, timely, and ...
Remote Utilization Review RN - RURR 26-06086
Santa Rosa, CA · Remote
$40 - $45/hr
Remote Utilization Review RN Location: Santa Rosa, CA Assignment Duration: 13 Weeks Schedule: Day ... Submit, track, and monitor authorizations, approvals, and denials * Maintain accurate, timely, and ...
Remote Utilization Review RN - RURR 26-06086
Santa Rosa, CA · Remote
$40 - $45/hr
Remote Utilization Review RN Location: Santa Rosa, CA Assignment Duration: 13 Weeks Schedule: Day ... Submit, track, and monitor authorizations, approvals, and denials * Maintain accurate, timely, and ...
Remote Utilization Review RN - RURR 26-06086
Ukiah, CA · Remote
$40 - $45/hr
Remote Utilization Review RN Location: Santa Rosa, CA Assignment Duration: 13 Weeks Schedule: Day ... Submit, track, and monitor authorizations, approvals, and denials * Maintain accurate, timely, and ...
Remote Utilization Review RN - RURR 26-06086
Ukiah, CA · Remote
$40 - $45/hr
Remote Utilization Review RN Location: Santa Rosa, CA Assignment Duration: 13 Weeks Schedule: Day ... Submit, track, and monitor authorizations, approvals, and denials * Maintain accurate, timely, and ...
Molina Healthcare is hiring for a Pharmacist in our UM/Prior Authorization department. This position is remote and can be worked from a variety of locations within the US. Shift times can be either 8 ...
Molina Healthcare is hiring for a Pharmacist in our UM/Prior Authorization department. This position is remote and can be worked from a variety of locations within the US. Shift times can be either 8 ...
Pharmacist, Prior Auth/Utilization Management, Remote
Long Beach, CA · On-site +1
$80.41K - $156.80K/yr
Molina Healthcare is hiring for a Pharmacist in our UM/Prior Authorization department. This position is remote and can be worked from a variety of locations within the US. Shift times can be either 8 ...
Pharmacist, Prior Auth/Utilization Management, Remote
Long Beach, CA · On-site +1
$80.41K - $156.80K/yr
Molina Healthcare is hiring for a Pharmacist in our UM/Prior Authorization department. This position is remote and can be worked from a variety of locations within the US. Shift times can be either 8 ...
Non-Clinical - Health and Information Management - Utilization Management Technician
Los Angeles, CA · Remote
$42/hr
Remote (UCLA will provide necessary equipment) Shift: M-F 8-5 PST Duration: 13 weeks Bill Rate: $42 ... authorization requests, as well as process prior authorization requests with accuracy and ...
Non-Clinical - Health and Information Management - Utilization Management Technician
Los Angeles, CA · Remote
$42/hr
Remote (UCLA will provide necessary equipment) Shift: M-F 8-5 PST Duration: 13 weeks Bill Rate: $42 ... authorization requests, as well as process prior authorization requests with accuracy and ...
Pharmacist, Prior Auth/Utilization Management, Remote
Long Beach, CA · Remote
$80.41K - $156.80K/yr
Molina Healthcare is hiring for a Pharmacist in our UM/Prior Authorization department. This position is remote and can be worked from a variety of locations within the US. Shift times can be either 8 ...
Pharmacist, Prior Auth/Utilization Management, Remote
Long Beach, CA · Remote
$80.41K - $156.80K/yr
Molina Healthcare is hiring for a Pharmacist in our UM/Prior Authorization department. This position is remote and can be worked from a variety of locations within the US. Shift times can be either 8 ...
Travel Utilization Review Nurse - $2,109 per week
Santa Rosa, CA · Remote
$2.11K/wk
Remote Utilization Review Registered Nurse - Specialty: Utilization Review - Shift: Day 5x8-Hour ... Prior Authorizations - Retrospective Review - Experience with InterQual Criteria Regulatory ...
Travel Utilization Review Nurse - $2,109 per week
Santa Rosa, CA · Remote
$2.11K/wk
Remote Utilization Review Registered Nurse - Specialty: Utilization Review - Shift: Day 5x8-Hour ... Prior Authorizations - Retrospective Review - Experience with InterQual Criteria Regulatory ...
Travel Utilization Review RN - $2,109 per week
Santa Rosa, CA · Remote
$2.11K/wk
... Pre-certification and prior authorizations - Appeals and denials - Utilize evidence-based ... remote UR experience or 3 years in a hospital setting - Experience with HMOs, IPAs, and Medicare ...
Travel Utilization Review RN - $2,109 per week
Santa Rosa, CA · Remote
$2.11K/wk
... Pre-certification and prior authorizations - Appeals and denials - Utilize evidence-based ... remote UR experience or 3 years in a hospital setting - Experience with HMOs, IPAs, and Medicare ...
Remote Prior Authorization Rn information
What is the difference between Remote Prior Authorization Rn vs Remote Medical Coder?
| Aspect | Remote Prior Authorization Rn | Remote Medical Coder |
|---|---|---|
| Credentials | RN license, certification in case management or utilization review | Certification in coding (CPC, CCS), high school diploma or equivalent |
| Work Environment | Healthcare facilities, insurance companies, telehealth | Medical offices, insurance companies, remote coding platforms |
| Industry Usage | Utilization review, patient authorization, insurance approval | Medical record review, billing, coding for insurance claims |
Remote Prior Authorization Rns focus on reviewing patient information to approve treatments, while Remote Medical Coders translate medical records into codes for billing. Both roles require healthcare knowledge but serve different functions within the healthcare industry.
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$40/hr
Other
Posted 7 days ago
Job description
Job Title: Registered Nurse - Utilization Review
Location: Santa Rosa, CA
Shift Details: Day Shift | 5x8 Hours | 08:00 AM - 04:30 PM
Contract Duration: 13 Weeks
Orientation: 40 Hours (Non-Billable)
Required Qualifications
- Active Registered Nurse (RN) License required
- Minimum 1-2 years acute care nursing experience preferred
- Experience in Utilization Review, Case Management, or similar role preferred
- Strong understanding of medical necessity, payer guidelines, and clinical documentation
- Knowledge of insurance authorization processes preferred
- Strong analytical, communication, and decision-making skills
- Ability to work independently in a remote environment
- Proficiency with EMR systems preferred (Epic experience a plus)
Job Responsibilities
- Perform utilization review of inpatient and outpatient cases
- Evaluate medical necessity based on clinical guidelines and payer policies
- Review patient records and documentation for appropriate level of care
- Collaborate with physicians, case managers, and insurance providers
- Process prior authorizations and continued stay reviews
- Document all review decisions accurately in EMR systems
- Identify cases requiring further clinical escalation
- Ensure compliance with regulatory, hospital, and insurance standards
- Support discharge planning and care coordination as needed
- Maintain productivity and quality standards in a remote setting
For more details contact at sthakur@navitashealth.com
About Navitas Healthcare, LLC certified WBENC and one of the fastest-growing healthcare staffing firms in the US providing Medical, Clinical and Non-Clinical services to numerous hospitals. We offer the most competitive pay for every position we cater. We understand this is a partnership. You will not be blindsided and your salary will be discussed upfront.