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Sarah Jenkins
Remote Prior Authorization Nurse jobs in the United States
Job type
Min. salary, $/year
Level
Healthcare organizations across the United States are seeking skilled professionals to fill prior authorization nurse remote jobs that support timely patient care decisions. With 500+ open positions available, qualified nurses can apply clinical expertise from anywhere in the country. Demand for this role continues to rise as insurers streamline utilization review processes.
Successful candidates bring clinical experience along with knowledge of insurance guidelines, medical necessity criteria, and utilization management systems. Strong communication skills help coordinate with physicians, case managers, and insurers. Attention to detail and sound clinical judgment are valued traits among prior authorization nurse vacancies, alongside an active RN license and EHR familiarity.
This remote setup has grown common as employers adopt flexible staffing to reach talent nationwide. Typical arrangements include secure platform access, structured schedules, and virtual team collaboration. Employers across the USA continue to hire a prior authorization nurse to manage rising patient volumes, making this a stable career path.
If you're ready to advance your nursing career with remote flexibility, now is the time to explore new opportunities in utilization management. Global Work AI connects skilled healthcare professionals with organizations eager to fill these roles quickly. Take the next step and discover how your expertise can make a meaningful impact today.
Infinx
Support the Patient Access Onshore department by managing prior authorization processes.
remote, United StatesFull TimeJunior (<2 years)
GoLean Health
Manage medication prior authorization requests using CoverMyMeds, including submission, tracking, and follow-up. Communicate with patients, pharmacies, and insurance representatives while maintaining accurate records in Athenahealth.
remote, United States$10k – $12k/yrFull TimeJunior (<2 years)GoLean Health
Manage patient communication, appointment scheduling, and procedure coordination. Conduct insurance eligibility verification and submit prior authorization requests. Track pending procedures and ensure all necessary preparations are completed before scheduled appointments.
remote, United States$12k/yrFull TimeJunior (<2 years)
Elara Caring
Manage patient insurance authorizations and eligibility verification processes. Ensure compliance with Medicaid and insurance requirements while maintaining accurate records. Collaborate with healthcare professionals to facilitate timely patient care and resolve any insurance-related issues.
remote, Dallas, TX, United States$46k – $52k/yrFull TimeJunior (<2 years)
Mass General Brigham
Review and process prior authorization and referral requests for medical services. Ensure insurance eligibility and medical necessity by gathering and submitting documentation in compliance with HIPAA.
remote, United States$40k – $57k/yrFull TimeJunior (<2 years)
Centene Corporation
Analyze prior authorization requests for medical necessity and appropriate care levels. Collaborate with healthcare providers and teams to ensure timely service reviews. Document and maintain clinical information in health management systems, ensuring compliance with regulations.
remote, TX, United States$54k – $98k/yrFull TimeJunior (<2 years)
Tenet Healthcare Corporation
Handle scheduling and financial clearance operations, including verifying patient demographics and insurance information, securing payments, and performing collection efforts.
remote, United States$32k – $48k/yrFull TimeEntry with Degree
Allegiance Mobile Health
Obtain, verify, and document insurance authorizations for ground ambulance transports. Review transport requests, verify patient eligibility, and submit authorization requests. Monitor pending requests, manage emergency transports, and communicate authorization status to relevant teams.
remote, Austin, TX, United StatesFull TimeJunior (<2 years)
Florida Cancer Specialists
Perform prior authorizations and appeals for oncology medications, interacting with patients and healthcare providers. Conduct clinical reviews of patient charts and process appeals for denials. Obtain prior authorization approvals using online systems and escalate complex issues to clinicians.
remote, FL, United StatesFull TimeMiddle (2-4 years)
American Oncology Network
Manage the authorization process for pharmacy orders, including submitting prior authorizations and following up on requests. Coordinate appeals and provide backup support to pharmacy staff.
remote, FL, United States$32k – $60k/yrFull TimeJunior (<2 years)
Seven Counties Services
Evaluate and submit authorizations to MCOs, Medicare, and commercial insurance based on medical necessity. Collaborate with providers, nurses, and pharmacies to advocate for client needs. Conduct chart audits for medical necessity and compliance standards.
remote, KY, United StatesFull TimeSenior (5+ years)
The US Oncology Network
Review and process chemotherapy treatment authorizations, ensuring compliance with reimbursement guidelines. Communicate with medical staff regarding insurance restrictions and provide feedback on documentation issues.
remote, TX, United StatesFull TimeMiddle (2-4 years)
CenterWell
Supervise daily authorization activities, ensuring adherence to standards and procedures. Provide guidance to staff and management on authorization issues, maintain assigned portfolios, and develop plans to meet authorization objectives.
remote, United States$65k – $89k/yrFull TimeLead / Manager
Advocate Health
Obtain complex authorizations for inpatient and outpatient services, including chemotherapy and surgeries. Interpret medical records to establish medical necessity and manage high-volume requests.
remote, United States$44k – $66k/yrFull TimeMiddle (2-4 years)
Hennepin Healthcare
Coordinate pre-authorizations for patients, ensuring timely processing for scheduled and unscheduled services. Verify medical necessity according to CMS standards and communicate coverage information. Obtain pre-certifications from third-party payers and follow up on submissions and denials.
remote, United StatesFull TimeSenior (5+ years)
Polaris Pharmacy Services
Manage and identify rejected pharmacy claims to ensure maximum payer reimbursement and timely billing. Research and resolve claims by collaborating with Medicare D plans, insurance companies, and Medicaid.
remote, FL, United StatesFull TimeJunior (<2 years)
CareOregon
Provide technical and clerical support in assigned focus areas, including verifying member eligibility and provider networks. Process authorization requests based on insurance types, ensuring compliance with departmental policies and regulations.
remote, IA, United States$46k – $56k/yrFull TimeJunior (<2 years)
Squad Health
Manage the end-to-end prior authorization process for specialty medications, including verifying insurance benefits and reviewing clinical documentation. Prepare, submit, and track authorization requests through various channels.
remote, United StatesFull TimeEntry with Degree
Amerihealth Caritas
Supervise a remote team of up to 15 Utilization Management Reviewers, providing daily oversight and support. Manage daily operations, including workflow and inventory of prior authorization requests.
remote, LA, United StatesFull TimeLead / Manager
Navitus Health Solutions, LLC
Perform Prior Authorizations and Drug Utilization Reviews, including concurrent, retrospective, and prospective components. Interface with physicians and pharmacists regarding beneficiaries’ benefits and therapeutic interventions.
remote, AL, United States$101k/yrFull TimeJunior (<2 years)
Orsini Healthcare
Oversee daily operations for Benefits Verification (BV) and Prior Authorization (PA) staff, including work assignments and productivity follow-up. Conduct routine and complex audits of benefit investigations and authorization submissions to ensure compliance.
remote, Elk Grove Village, IL, United States$50k/yrFull TimeSenior (5+ years)
Triton Medical Solutions
Coordinate and obtain prior authorizations from insurance companies. Review procedure requests and documentation for medical necessity, contact providers for additional information, and submit authorizations with correct codes.
remote, United StatesFull TimeJunior (<2 years)
WellSky
Review acute and post-acute authorization requests and medical records for medical necessity. Manage medical necessity denials from notification to resolution, ensuring compliance with clinical guidelines.
remote, United StatesFull TimeMiddle (2-4 years)GoLean Health
Verify patient eligibility and benefits with insurance plans and Medicaid. Process prior authorization requests and track their status. Support patient intake by ensuring documentation is complete and coordinate with front-desk staff.
remote, United States$14k/yrPart TimeJunior (<2 years)
TrueScripts Management Services
Lead the Prior Authorization department, establishing goals and metrics aligned with organizational objectives. Oversee daily operations to ensure quality and efficiency, while managing vendor relationships and performance.
remote, Washington, IL, United StatesFull TimeDirector
UPMC
Perform clinical reviews of Prior Authorization and pharmacy utilization management requests. Manage pharmacy utilization and provide expertise in the prior authorization and appeals process for medications.
remote, PA, United StatesFull TimeJunior (<2 years)
Ascertain
Process prior authorizations for imaging and radiology procedures, oversee automated submissions, and collaborate with leadership and product teams to enhance workflows. Review insurance information, gather clinical documentation, submit requests to payors, and manage denials and appeals.
remote, United StatesFull TimeLead / ManagerCommunity Care Cooperative (C3)
Process and submit prior authorizations for FQHCs, ensuring accuracy and efficiency. Communicate with providers, patients, and pharmacy teams to optimize patient care. Track and report cost savings from patient assistance programs and provide updates to management.
remote, MA, United StatesFull TimeJunior (<2 years)
UOMUOMUS
Conduct ongoing reviews for clinical utilization and authorization needs. Coordinate with Nurse Case Manager and healthcare team to ensure optimal patient outcomes. Maintain communication regarding authorization status and potential treatment delays.
remote, United StatesFull TimeJunior (<2 years)
Gainwell Technologies LLC
Oversee and guide teams to deliver superior service and achieve account goals. Manage staff performance, optimize processes, and maintain quality standards. Cultivate relationships with account leaders to improve operational products and services.
remote, United States$76k – $108k/yrFull TimeLead / Manager
Metropolitan Jewish Health System
Process requests for elective services, out of network requests, and durable medical equipment according to departmental criteria and Medicare guidelines. Communicate elective hospital admissions to Utilization Management Coordinators to ensure continuity of care.
remote, New York, NY, United States$61k – $76k/yrFull TimeJunior (<2 years)
NYX Health, LLC
Complete insurance verifications, submit and track prior authorizations, gather required documentation, and communicate with insurance payors and clinicians.
remote, United States$42k – $46k/yrFull TimeMiddle (2-4 years)
UnitedHealth Group
Coordinate and facilitate internal and external authorizations for patients. Process authorizations and submit clinical documentation to insurance carriers. Document prior authorization information and notify staff of delays.
remote, OR, United States$36k – $65k/yrFull TimeJunior (<2 years)Tenet Healthcare Corporation
Verify patient benefits and authorization requirements for services. Secure necessary authorizations for inpatient, outpatient, and emergency services. Collaborate with internal and external clients to facilitate the authorization process and address complex issues.
remote, United States$32k – $48k/yrFull TimeJunior (<2 years)
St. Francis Medical Center
Review requests for prior authorization of medical services, including surgeries and home health. Determine benefits and document accurately according to healthcare guidelines. Act as a liaison to ensure smooth workflows and transitions of information for authorizations.
remote, United StatesFull TimeEntry with Degree
Ensemble Health Partners
Perform initial and concurrent insurance authorization securement, clinical submission, and denial prevention for hospitalized patients. Conduct staff training, quality audits, and manage unbilled clean-up and pre-bill denials processing.
remote, United States$38k – $50k/yrFull TimeSenior (5+ years)
Soleo Health Inc
Conduct clinical reviews for prior authorization requests, ensuring accuracy and completeness. Evaluate clinical documentation against payer criteria and submit requests to Pharmacy Benefit Managers (PBMs). Communicate with PBMs to resolve authorization issues and mitigate denials.
remote, United StatesFull TimeJunior (<2 years)
Staffing for Doctors
Coordinate patient referrals and insurance prior authorizations using eClinicalWorks (eCW), ensuring all necessary documentation is submitted and tracked. Manage inbound and outbound calls, schedule patient appointments, and process intake and registration.
remote, United StatesFull TimeJunior (<2 years)
Gebbs Healthcare Solutions Inc
Manage prior authorization requests for various services, ensuring accurate documentation and tracking through payer portals. Verify patient eligibility and benefits, monitor pending requests, and handle denials and appeals.
remote, United StatesFull TimeJunior (<2 years)
Global Medical Virtual Assistants
Manage the end-to-end prior authorization process, including submitting and tracking requests. Serve as the liaison between healthcare providers, insurance companies, and patients. Verify patient insurance coverage and benefits, and prepare appeal packages for denied requests.
remote, United States$10k/yrFull TimeJunior (<2 years)10,000,000+ more jobs available!
