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Remote Prior Authorization Rn Jobs in Michigan (NOW HIRING)

Sedgwick

RN Field Case Manager

Grand Rapids, MI · On-site +1

$74K - $95K/yr

Must be an RN and prefers 1.5 years of prior Field Case Manager workers compensation experience ... remote work environment that allows face to face interaction with injured workers and medical ...

York Risk Services

RN Field Case Manager

Grand Rapids, MI · On-site +1

$74K - $95K/yr

Must be an RN and prefers 1.5 years of prior Field Case Manager workers compensation experience ... remote work environment that allows face to face interaction with injured workers and medical ...

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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.

What are the most commonly searched types of Prior Authorization Rn jobs in Michigan? The most popular types of Prior Authorization Rn jobs in Michigan are:
What are popular job titles related to Remote Prior Authorization Rn jobs in Michigan? For Remote Prior Authorization Rn jobs in Michigan, the most frequently searched job titles are:
What job categories do people searching Remote Prior Authorization Rn jobs in Michigan look for? The top searched job categories for Remote Prior Authorization Rn jobs in Michigan are:
Remote Prior Authorization Rn jobs near you
Infographic showing various Remote Prior Authorization Rn job openings in Michigan as of July 2026, with employment types broken down into 91% Full Time, 6% Part Time, and 3% Contract. Highlights an 1% In-person, and 99% Remote job distribution.
Central Authorization Specialist /Full Time/ Remote-Michigan Residents

Central Authorization Specialist /Full Time/ Remote-Michigan Residents

Corporate Services

Detroit, MI • Remote

$17.75 - $23.75/hr

Other

Posted 21 days ago

Job description

The purpose of the Central Authorization Specialist position is to centrally facilitate the successful procuring of insurance authorizations for ordered procedures and post-operative care. This will be done through quality validations of obtained authorizations as well as continuous education and opportunity feedback to a multi-disciplinary team with the underlying objective of managing the cost of care and providing timely and accurate information to payors'. The Central Authorization Specialist helps drive change by identifying areas where performance improvement is needed (e.g., day to day workflow, education, process improvements, patient satisfaction). The Central Authorization Specialist is accountable for a designated caseload and plans effectively in order to meet demands and support resources procuring authorizations. Under general supervision and in accordance with established policies and procedures the specific functions within this role include: Subject matter expertise of precertification and payor authorization processes. Ensure successful authorizations are procured by ordering physician offices through validation of work effort and education of procuring staff. Ensure feedback relevant to successful authorization procurement is obtained from back end coding, billing and denial management resources and distributed to ordering physicians and authorization procurement staff to promote continuous improvement. Application of process improvement methodologies. The responsibilities includes acting as a centralized resource for assigned specialty across all sites of practice to ensure standardized and consistent procurement of authorizations. EDUCATION/EXPERIENCE REQUIRED: High School or 3 - 5 years related experience and/or training; or equivalent combination of education and experience, required. Minimum of 3-5 years of experience in a medical clinic setting or training in a hospital or corporate setting; must be highly computer literate, required. Two years of experience related to healthcare insurance verification and/or billing required. Approximately two to three years progressively more responsible related work experience necessary in order to gain in-depth understanding or organizational policies, procedures and operations, in order to assume a variety of high-level administrative details. Coding knowledge. Knowledge of clinical terminology. Understanding of patient treatment plans for purposes of obtaining authorizations. Ability to interpret RN or Physician notes in order to facilitate obtaining authorizations. Ability to evaluate & communicate to RN/Physician staff additional requirements or roadblocks. Additional coursework in business, computers or health care administration, preferred. Experience in a medical or surgical specialty clinic, preferred. Ability to interpret insurance records and related documentation. Current working knowledge of hospital operations, utilization management, case management, and managed care reimbursement, preferred. General understanding of revenue cycle with an emphasis on billing, coding, charge capture and reimbursement, preferred. Organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components. Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients and their families if required. Strong oral and written communication skills required. Strong analytical and data management. Ability to work with all levels of management. Strong interpersonal communication and negotiation skills and experience interacting with clinicians and finance personnel.

EDUCATION/EXPERIENCE REQUIRED:

  • High school diploma or 3-5 years of related experience/training (or equivalent combination), required
  • Minimum 3-5 years of experience in a medical clinic setting or training in a hospital/corporate setting; must be highly computer literate, required
  • Minimum 2 years of experience in healthcare insurance verification and/or billing, required
  • 2-3 years of progressively responsible experience with organizational policies, procedures, and operations to handle high-level administrative responsibilities
  • Knowledge of coding and clinical terminology
  • Understanding of patient treatment plans for obtaining authorizations
  • Ability to interpret RN/Physician notes to facilitate authorizations
  • Ability to identify and communicate additional requirements or roadblocks to clinical staff
  • Ability to interpret insurance records and related documentation
  • Strong understanding of administrative workflows and healthcare processes

Preferred Qualifications:

  • Additional coursework in business, computers, or healthcare administration
  • Experience in a medical or surgical specialty clinic
  • Working knowledge of hospital operations, utilization management, case management, and managed care reimbursement
  • General understanding of the revenue cycle (billing, coding, charge capture, reimbursement)

Skills & Competencies:

  • Strong organizational and time management skills; ability to prioritize multiple tasks
  • Ability to work independently and exercise sound judgment
  • Strong oral and written communication skills
  • Strong analytical and data management skills
  • Ability to work with all levels of management
  • Strong interpersonal and negotiation skills, with experience interacting with clinicians and finance personnel
 
 
 
Additional Information
  • Organization: Corporate Services
  • Department: CBO Central Authorization Unit
  • Shift: Day Job
  • Union Code: Not Applicable

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