Remote Utilization Management RN – Prior Authorization

About the role

This remote contract position supports a fast‑growing Medicare Advantage health plan by handling prior authorization requests. The Utilization Management RN will work independently in a high‑volume environment, applying clinical guidelines to ensure appropriate medical necessity decisions.

Key responsibilities

• Review and adjudicate prior authorization requests for medical necessity.
• Apply InterQual and Milliman clinical guidelines to determine approvals or denials.
• Maintain a steady case queue while meeting established turnaround times.
• Communicate decisions clearly with providers and internal teams.
• Document all actions accurately to ensure compliance with regulatory standards.

Required profile

• Active RN license.
• Prior authorization experience within a health‑plan or payer setting.
• Strong clinical judgment and ability to make independent decisions.
• Comfortable working in a high‑volume, fast‑paced workflow.

Required skills

• Proficiency with InterQual clinical guidelines.
• Proficiency with Milliman clinical guidelines.

What we offer

• Contract role through the end of the year with potential extension.
• Consistent workflow and case volume.
• Opportunity to deepen expertise in prior authorization within a growing payer organization.