Remote Utilization Review Manager Jobs in New York

Specialised Part-Time Consulting OpportunityWe are sharing a specialised part-time consulting opportunity for United States-based healthcare professionals experienced in prior authorization, utilization management, clinical review, medical necessity criteria, payer authorization workflows, documentation review, and healthcare operations.This role supports current and upcoming remote consulting opportunities focused on AI-assisted prior authorization evaluation, clinical justification review, payer workflow assessment, and high-quality project execution. Selected professionals will apply clinical and authorization expertise to evaluate AI-generated prior authorization recommendations, review medical necessity documentation, identify workflow or compliance issues, and provide structured feedback based on detailed project criteria.Key ResponsibilitiesProfessionals in this role may contribute to:Review end-to-end prior authorization workflows for medical and clinical services across multiple payer typesEvaluate AI-generated prior authorization recommendations and clinical justification drafts for accuracy, completeness, and appropriatenessAssess clinical documentation against InterQual, MCG, payer-specific criteria, or equivalent medical necessity standardsIdentify missing documentation, weak clinical rationale, incorrect payer logic, or unsupported authorization recommendationsReview workflows involving commercial, Medicare Advantage, Medicaid, and other payer authorization requirementsAssess authorization status tracking, denial outcomes, appeal pathways, escalation processes, and turnaround time expectationsEvaluate prior authorization workflows across multiple specialties, service types, clinical settings, and payer requirementsSupport review of KPIs such as authorization approval rates, turnaround times, denial rates, and workflow bottlenecksAnnotate AI-generated prior authorization outputs and provide structured clinical feedback to support quality improvementExplain review decisions clearly, consistently, and with strong clinical and utilization management judgmentEvaluate outputs for alignment with payer requirements, CMS guidance, clinical review criteria, and operational best practicesFollow detailed task instructions, quality criteria, and project-specific review guidelines accuratelyIdeal ProfileStrong candidates may have:5+ years of experience in prior authorization, utilization management, clinical review, payer authorization, or related healthcare operationsAt least 2 years of experience in a management, team lead, supervisor, or operational oversight roleStrong clinical background with knowledge of medical necessity criteria such as InterQual, MCG, or equivalent review standardsDeep familiarity with commercial, Medicare Advantage, and Medicaid prior authorization requirementsExperience managing authorization workflows across multiple specialties, payers, and service typesProficiency with authorization management systems and EHR platforms such as Epic, Cerner, or similar systemsExceptional written and verbal English communication skillsHigh attention to detail and ability to critically evaluate clinical documentation and AI-generated outputsEducational BackgroundProfessional background in prior authorization, utilization management, clinical review, nursing, healthcare operations, payer operations, medical necessity review, or care coordination is highly relevantClinical licensure such as Registered Nurse, Licensed Practical Nurse, or equivalent clinical credential may be especially valuable depending on project scopeExperience in physician office, hospital, health system, payer, managed care, or health plan prior authorization operations may support project fitPractical experience with EHR systems, authorization platforms, payer portals, clinical documentation review, and escalation workflows may be especially relevantWhy This OpportunityApply prior authorization and clinical review expertise to structured remote healthcare project workContribute to high-quality AI-assisted authorization workflow and medical necessity evaluationUse payer criteria knowledge, documentation review skills, and utilization management judgment in a focused review environmentWork on flexible assignments aligned with clinical operations, prior authorization, payer workflows, and patient access expertiseRemote structure with competitive hourly compensationContract DetailsIndependent contractor roleFully remote with flexible schedulingUnited States-based professionals are required for this opportunityPart-time project-based commitment depending on availability, onboarding status, and project needsCompetitive rates of up to $80 per hour depending on prior authorization experience, clinical background, management experience, and project scopeWeekly payments via Stripe or WiseProjects may be extended, shortened, or adjusted depending on scope and performanceWork will not involve access to confidential or proprietary information from any employer, client, or institutionAbout the PlatformThis opportunity is available through 24-MAG LLC. 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