Location: MUST reside in NJ, PA, NY, CT, or MD

Schedule: Mon–Fri, 8 AM–5 PM EST Work Setup: Remote, with first and last day in office

Training: 2 weeks, including mentorship and case work

Caseload: 10–35 cases/day, based on demand

Role Overview

As a Prior Authorization RN, you'll ensure patients receive timely, medically appropriate, and cost-effective care. You’ll assess clinical needs, coordinate care plans, and advocate for members across the healthcare continuum.

Key Responsibilities

• Review inpatient stays and services for medical necessity
• Coordinate care plans across internal and external providers
• Monitor quality and cost-effectiveness of care delivery
• Advocate for patients and families across care settings
• Refer members to case/disease management programs
• Document accurately and communicate with care teams
• Promote self-care while managing resource utilization
  
  

✅ Qualifications

• Reside in NJ, PA, NY, CT, or MD
• Active NJ or Compact RN license
• 3+ years clinical RN experience
• 2+ years in Prior Authorization at a health plan
• Proficient in Microsoft Office and Windows-based tools
• Knowledge of hospital systems and payment structures
• Strong understanding of care/case/disease management
  
  

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