ZipRecruiter

Log In

2

Remote Prior Authorization Rn Jobs in Boca Raton, FL

SPECIALTY RX, Inc.

Billing Representative- Remote

Sunrise, FL · On-site +1

$17 - $22.25/hr

Submit prior authorizations for State insurance * Interact with insurance company on daily basis, i.e., overrides, rejections, and insurance updates * Interact with client facilities staff, PDP ...

Seaside Home Health

Clinical Manager

Delray Beach, FL · Remote

The Part-Time QA Nurse is a remote-based RN who plays a critical role in ensuring the clinical documentation integrity, regulatory compliance, and accreditation readiness of our Florida-based home ...

Scribe-X

Remote Medical Scribe

Fort Lauderdale, FL · Remote

$14 - $17/hr

Anyone looking to begin a career in medicine (MD, DO, PA, NP, or RN) should consider becoming a medical scribe first! Scribe Pay Structure: $11/hour - No scribe experience $12/hour - 6+ months scribe ...

previous pagenext page

Showing results 21-40

All JobsPrior Authorization Rn JobsRemote Prior Authorization Rn JobsRemote Prior Authorization Rn Jobs in Boca Raton, FL

Remote Prior Authorization Rn information

See Boca Raton, FL salary details

$7

$40

$68

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

As of Sep 10, 2026, the average hourly pay for remote prior authorization rn in Boca Raton, FL is $40.09, according to ZipRecruiter salary data. Most workers in this role earn between $29.90 and $47.45 per hour, depending on experience, location, and employer.

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 popular job titles related to Remote Prior Authorization Rn jobs in Boca Raton, FL?

For Remote Prior Authorization Rn jobs in Boca Raton, FL, the most frequently searched job titles are:

What job categories do people searching Remote Prior Authorization Rn jobs in Boca Raton, FL look for?

The top searched job categories for Remote Prior Authorization Rn jobs in Boca Raton, FL are:

What cities near Boca Raton, FL are hiring for Remote Prior Authorization Rn jobs?

Cities near Boca Raton, FL with the most Remote Prior Authorization Rn job openings:

Remote Prior Authorization Rn jobs near you
Infographic showing various Remote Prior Authorization Rn job openings in Boca Raton, FL as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 19% Part Time, 1% Temporary, and 2% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $83,383 per year, or $40.1 per hour.

Manager, Clinical Appeals

Cooper City, FL • Remote

Health Business Solutions LLC
Health Care and Social Assistance • 51 - 200 employees
Learn more about Health Business Solutions LLCexternal

Full-time

Re-posted 29 days ago

Job description

Job Summary:

We are seeking an experienced and highly organized Manager of Clinical Appeals to lead our clinical appeals operations across commercial and government payers. This role is responsible for overseeing day-to-day activities of clinical appeal specialists, managing appeal strategy execution, ensuring quality and compliance, and meeting client-specific performance goals.

The ideal candidate brings a strong background in clinical review, medical necessity denials, payer appeal processes, and team leadership—ideally across both U.S. and offshore teams (e.g., Philippines). This position is critical to ensuring timely and effective resolution of denied claims, supporting revenue recovery efforts, and maintaining payer and regulatory compliance.

Key Responsibilities:

  • Manage the full-cycle clinical appeals process across multiple payer types, with a focus on government (e.g., Medicare, Medicaid) and commercial payers.
  • Lead and support a team of nurses, clinical reviewers, and appeal specialists—including potential offshore (Philippines-based) staff.
  • Monitor appeal workloads, productivity, and turnaround times to ensure all appeal deadlines and client service level agreements (SLAs) are met.
  • Review and approve complex or high-value clinical appeal cases, ensuring clinical accuracy and compliance with payer guidelines.
  • Maintain up-to-date knowledge of medical necessity criteria, payer policies, NCDs/LCDs, and applicable CMS regulations.
  • Train new and existing team members on clinical guidelines, appeal writing standards, and regulatory requirements.
  • Work cross-functionally with audit, legal, compliance, and operations teams to align on strategy and escalate trends or systemic payer issues.
  • Identify and implement process improvements to increase efficiency, reduce denials, and improve overturn rates.
  • Support the creation and refinement of appeal templates, clinical arguments, and documentation standards.
  • Generate and deliver performance and quality reports to leadership, identifying risks and opportunities for improvement.

Qualifications:

  • Registered Nurse (RN) or clinical degree required; Bachelor's degree in Nursing, Health Administration, or related field preferred.
  • 5+ years of experience in clinical appeals, utilization review, or medical necessity denials.
  • 2+ years in a leadership or supervisory role, preferably within a revenue cycle or payer appeals setting.
  • In-depth understanding of payer denial processes, especially Medicare Advantage, Medicaid Managed Care, and commercial plans.
  • Experience managing remote and/or offshore teams (Philippines experience preferred).
  • Strong working knowledge of ICD-10, CPT, and HCPCS coding as they relate to clinical justifications.
  • Excellent writing skills and the ability to clearly communicate complex clinical reasoning.
  • Familiarity with appeal submission portals, EHRs, and workflow platforms.
  • Knowledge of HIPAA, CMS, and NCQA standards.