Clinical Review Nurse Manager | Remote

Role Overview

Apply your expertise in prior authorization and clinical review to evaluate medical necessity determinations, authorization workflows, and utilization processes that support timely access to care.

What You Will Be Doing

• Review and assess prior authorization requests across a range of clinical services and specialties
• Evaluate medical necessity determinations against established clinical review criteria and payer requirements
• Assess authorization recommendations and clinical justification documentation for accuracy and completeness
• Cookordinate and optimize workflows involving providers, clinical teams, and payers
• Monitor authorization outcomes, denial trends, turnaround times, and process performance metrics
• Support appeals, escalation processes, and workflow improvement initiatives
• Provide structured feedback to improve authorization review quality and consistency

Who We Are Looking For

• Experienced professionals in prior authorization, utilization management, or clinical review operations
• Strong understanding of medical necessity criteria, payer policies, and authorization requirements
• Experience managing complex authorization workflows across multiple specialties and service lines
• Familiarity with authorization management platforms and electronic health record systems
• Clinical licensure or relevant utilization management certifications are highly valued
• Excellent analytical, communication, and documentation review skills

Role Details

• Compensation: $150 per hour
• Work style: Fully remote, flexible independent contract
• Duration: Ongoing project-based engagement

How To Apply

Click Easy Apply to proceed

Shortlisted candidates will be contacted with next steps