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Remote Prior Authorization Rn Jobs in Florida (NOW HIRING)

Ennoble Care

Care Coordinator

Orlando, FL · Remote

$75K - $85K/yr

... RN with strong organizational skills who thrives in a fast-paced, remote healthcare environment ... Serve as first point of escalation for CC team questions on referrals, prior authorizations, DME ...

Ennoble Care

Care Coordinator

Orlando, FL · Remote

$75K - $85K/yr

... RN with strong organizational skills who thrives in a fast-paced, remote healthcare environment ... Process and route incoming referrals, lab orders, prior authorizations, and home health orders to ...

Ennoble Care

Care Coordinator

Orlando, FL · Remote

$75K - $85K/yr

... RN with strong organizational skills who thrives in a fast-paced, remote healthcare environment ... Process and route incoming referrals, lab orders, prior authorizations, and home health orders to ...

Ennoble Care

Care Coordinator

Orlando, FL · Remote

$75K - $85K/yr

... RN with strong organizational skills who thrives in a fast-paced, remote healthcare environment ... Process and route incoming referrals, lab orders, prior authorizations, and home health orders to ...

DermaVe Spa

Registered Nurse Trainer

Orlando, FL · Remote

$22 - $27/hr

Registered Nurse Trainer Employment Type: Full-Time Work Schedule: 80% Remote / 20% Travel Role Overview We are looking for a licensed RN or APRN with experience in aesthetics or med spa settings to ...

Dermave Spa

Registered Nurse Trainer

Orlando, FL · On-site +1

$22 - $27/hr

Registered Nurse Trainer Employment Type: Full-Time Work Schedule: 80% Remote / 20% Travel Role Overview We are looking for a licensed RN or APRN with experience in aesthetics or med spa settings to ...

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Remote Prior Authorization Rn information

What is the difference between Remote Prior Authorization Rn vs Remote Medical Coder?

AspectRemote Prior Authorization RnRemote Medical Coder
CredentialsRN license, certification in case management or utilization reviewCertification in coding (CPC, CCS), high school diploma or equivalent
Work EnvironmentHealthcare facilities, insurance companies, telehealthMedical offices, insurance companies, remote coding platforms
Industry UsageUtilization review, patient authorization, insurance approvalMedical 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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Remote Prior Authorization Rn jobs near you
Care Review Clinician (RN) - Remote in FL

Care Review Clinician (RN) - Remote in FL

Molina Healthcare

Orlando, FL • Remote

$26.41 - $43/hr

Full-time

Posted 21 days ago

Molina Healthcare rating

8.0

Company rating: 8.0 out of 10

Based on 192 frontline employees who took The Breakroom Quiz

145th of 261 rated insurance

Job description

JOB DESCRIPTION 

Must reside in Florida

Job Summary

Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. 
Essential Job Duties 
• Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. 
• Analyzes clinical service requests from members or providers against evidence based clinical guidelines. 
• Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. 
• Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. 
• Processes requests within required timelines. 
• Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner. 
• Requests additional information from members or providers as needed. 
• Makes appropriate referrals to other clinical programs. 
• Collaborates with multidisciplinary teams to promote the Molina care model. 
• Adheres to utilization management (UM) policies and procedures. 
Required Qualifications 
• At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. 
• Registered Nurse (RN). License must be active and unrestricted in state of practice. 
• Ability to prioritize and manage multiple deadlines. 
• Excellent organizational, problem-solving and critical-thinking skills. 
• Strong written and verbal communication skills. 
• Microsoft Office suite/applicable software program(s) proficiency. 
Preferred Qualifications 
• Certified Professional in Healthcare Management (CPHM). 
• Recent hospital experience in an intensive care unit (ICU) or emergency room.

  • Utilization Management (UM) experience highly preferred. 

#PJHS3

#LI-AC1
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $26.41 - $43 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

What Molina Healthcare employees say

Pay

Benefits

Hours and flexibility

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About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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