Part time job UM Prior Authorization Nurse, RN (Work from home)-id-9103

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🏥 Remote Prior Authorization Nurse (RN) – Part-Time | NeueHealth

📍 Location: Remote – Must hold an active, unrestricted RN license in California
đź•’ Schedule: Part-Time | Flexible hours
💼 Department: Utilization Management (UM) – Prior Authorization
💲 Compensation Estimate (CA only): $74,260 – $111,391 annually (prorated for part-time)
✨ Benefits: 401(k) with match, PTO, holidays, health, life & disability coverage

About NeueHealth

At NeueHealth, we’re reimagining healthcare to be value-driven, accessible, and consumer-focused. We serve a wide population across the ACA Marketplace, Medicare, and Medicaid, bridging the gap between providers, payors, and patients to ensure high-quality, affordable healthcare for all.

We are growing and looking for a Part-Time Prior Authorization RN who shares our passion for better care delivery—from the comfort of your home.

About the Role

As a Remote Prior Authorization Nurse, you’ll review, evaluate, and process prior authorization (PA) requests for treatments, diagnostics, medications, and procedures to ensure clinical appropriateness and coverage compliance. You’ll collaborate closely with our Medical Directors and providers to ensure high-quality, cost-effective care for our members.

What You’ll Do

âś… Authorization & Review

âś… Communication & Collaboration

  • Serve as a liaison between providers, patients, and health plans

  • Communicate approval or denial decisions clearly and professionally

  • Partner with Medical Directors on adverse determinations and appeals

  • Ensure regulatory compliance with authorization notifications and appeals processes

âś… Documentation & Compliance

  • Accurately document all decisions in EMRs or authorization systems

  • Maintain compliance with state, federal, and health plan regulations

  • Stay current on changing medical policies and clinical criteria

âś… Quality & Improvement

  • Analyze trends in authorization denials and support process enhancements

  • Participate in audits, training, and team meetings to uphold quality standards

Required Qualifications

Preferred Qualifications

  • Experience in a managed care setting or with MCG guidelines

  • Certifications like CPUR, CCM, or ACM are a strong plus

  • Bilingual or multilingual skills are welcome!

đź’ˇ Why Join NeueHealth?

  • Work from home with a mission-driven team focused on transforming healthcare

  • Competitive pay aligned with experience and part-time scheduling

  • Enjoy flexibility and purpose-driven work that aligns with your clinical expertise

  • Join a diverse, inclusive, and equity-focused organization making a real impact

đź’Ľ Compensation & Benefits (Part-Time)

  • Competitive hourly rate within a prorated annual range: $74,260–$111,391

  • Paid time off (PTO) and holidays

  • Access to 401(k) with company match

  • Eligible for health, life, and disability insurance options

Diversity & Inclusion at NeueHealth

NeueHealth is proud to be an Equal Opportunity Employer. We value diversity and strive to create an inclusive environment for all team members. We welcome applicants of all backgrounds, including veterans and individuals with disabilities.

🚀 Ready to Make a Difference?

Apply today and help shape the future of healthcare—from your home.

đź”— Learn more at www.neuehealth.com

Part time job UM Prior Authorization Nurse, RN (Work from home)-id-9103

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