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Remote Prior Authorization Rn Jobs in Concord, NC

Sagility

RN Utilization Management Reviewer

Concord, NC · Remote

$35 - $40/hr

Conducts timely clinical decision review for services requiring prior authorization in a variety of ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...

Sagility

RN Utilization Management Reviewer

Concord, NC · Remote

$35 - $40/hr

Conducts timely clinical decision review for services requiring prior authorization in a variety of ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...

Sagility LLC

RN Utilization Management Reviewer

Concord, NC · Remote

$35 - $40/hr

Conducts timely clinical decision review for services requiring prior authorization in a variety of ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...

Sagility LLC

RN Utilization Management Reviewer

Concord, NC · Remote

$35 - $40/hr

Conducts timely clinical decision review for services requiring prior authorization in a variety of ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...

Insight Global

Remote Pharmacist

Salisbury, NC · Remote

$59/hr

The Pharmacist, Prior Authorization (PA) & Appeals, is responsible for reviewing and evaluating prior authorization and appeals requests to determine coverage based on clinical guidelines, pharmacy ...

McKesson

Field Reimbursement Manager

Concord, NC · On-site +1

... Prior Authorization,Claims Assistance, and Appeals) and educating the office on Payer landscape and services available through both remote interaction and on-site training. This position is client ...

McKesson

Field Reimbursement Manager

Concord, NC · On-site +1

... Prior Authorization,Claims Assistance, and Appeals) and educating the office on Payer landscape and services available through both remote interaction and on-site training. This position is client ...

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Remote Prior Authorization Rn information

See Concord, NC salary details

$6

$39

$67

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

As of Sep 1, 2026, the average hourly pay for remote prior authorization rn in Concord, NC is $39.35, according to ZipRecruiter salary data. Most workers in this role earn between $29.33 and $46.59 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 Concord, NC?

For Remote Prior Authorization Rn jobs in Concord, NC, the most frequently searched job titles are:

What job categories do people searching Remote Prior Authorization Rn jobs in Concord, NC look for?

The top searched job categories for Remote Prior Authorization Rn jobs in Concord, NC are:

What cities near Concord, NC are hiring for Remote Prior Authorization Rn jobs?

Cities near Concord, NC 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 Concord, NC as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 14% Part Time, 2% Temporary, and 3% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $81,838 per year, or $39.3 per hour.

RN Utilization Management Reviewer

Sagility

Concord, NC • Remote

$35 - $40/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 24 days ago

Sagility rating

4.6

Company rating: 4.6 out of 10

Based on 29 frontline employees who took The Breakroom Quiz

63rd of 72 rated call and contact centers

Job description

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.

Job title:

RN Utilization Management Reviewer

Job Description:

We are currently hiring a talented RN, Utilization Management Reviewer. This role will be responsible in day-to-day timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring the client meets CMS compliance standards in the area of service decisions and organizational determinations. Successful candidates must hold a valid, current license issued by the Massachusetts Board of Registration in Nursing.

Key responsibilities:

  • Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical areas, including but not limited to surgical procedures, Medicare Part B medications, Long Term Services and Supports (LTSS), and Home Health (HH)
  • Applies established criteria (e.g., InterQual and other available guidelines) and employs clinical expertise to interpret clinical criteria to determine medical necessity of services
  • Communicates results of reviews verbally, in the medical record, and through official written notification to the primary care team, specialty providers, vendors and members in adherence with regulatory and contractual requirements
  • Provides decision-making guidance to clinical teams on service planning as needed
  • Works closely with Clinicians, Medical Staff and Peer Reviewers to facilitate escalated reviews in accordance with Standard Operating Procedures
  • Ensures accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy
  • Works with UM Manager and other clinical leadership to ensure that departmental and organizational policies and procedures as well as regulatory and contractual requirements are met
  • Additional duties as requested by supervisor
  • Maintains knowledge of CMS, State and NCQA regulatory requirements

Education Requirements:

  • RN - Associate's Degree required, Bachelor's Degree preferred
  • RN, current license issued by the Massachusetts Board of Registration in Nursing
  • CCM (Certified Case Manager) a plus

Required Experience (must have):

  • 1 to 2 years Utilization Management experience.
  • 2 or more years working in a clinical setting

Desired Experience (nice to have):

  • 2 or more years of Home Health Care experience
  • 2 or more years working in a Medicare Advantage health Plan

Required Knowledge, Skills & Abilities (must have):

  • Ability to complete assigned work in a timely and accurate manner
  • Knowledge of the Utilization management process
  • Ability to work independently

Desired Knowledge, Skills, Abilities & Language (nice to have):

  • Ability to apply predetermined criteria (e.g., Medical Necessity Guidelines, InterQual) to service decision requests to assess medical necessity
  • Flexibility and understanding of individualized care plans
  • Ability to influence decision making
  • Strong collaboration and negotiation skills
  • Strong interpersonal, verbal, and written communication skills
  • Comfort working in a team-based environment
  • Knowledge of Medicare and Mass health services and benefits

Salary: $35.00 - $40.00 Hourly pending experience.

Hours: Monday through Friday 9AM to 5:30PM Eastern Time. May require weekends

This is a fully remote work at home role. You must have a secure, private wok at home area with a hardwired internet connection with speeds greater than 5MB upload and 10MB download.

Sagility Offers Competitive Benefits Including:

  • Medical
  • Dental
  • Vision
  • Life Insurance
  • Short-Term and Long-Term Disability
  • Flexible Spending Account
  • Life Assistance Program
  • 401K with employer contribution
  • PTO and Sick Time
  • Tuition Reimbursement

Join our team, we look forward to talking with you!

An Equal Opportunity Employer/Vet/Disability

Location:

Work@Home USAUnited States of America

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