Remote Authorization Nurse & Payor Liaison

UPMC; Pittsburgh (Allegheny County); Hybrid; USD 70,000 - 90,000; Full time

Benefits offered by this job

Work from home eligible

Job summary

UPMC is hiring a full-time Authorization Nurse. The role supports UPMC departments by obtaining referrals and authorizations for admissions, hospital services, and treatments.

You will assess medical necessity using acute care knowledge and payer regulations, ensuring documentation is complete and communicating clinical information to physicians and executives. The position works Monday through Friday with rotating weekends and holidays, daylight hours, and eligibility to work from home.

Qualifications

• Active RN license in good standing.
• Experience with payer policies and medical necessity criteria is preferred.
• Strong communication and collaboration with care teams and payors.

Responsibilities

• Serve as liaison between care managers and payors to facilitate payor/physician contact.
• Communicate with Medical Directors, Attending Physicians and CFO regarding evaluation of medical appropriateness.
• Collaborate with departments to obtain information supporting authorization and level of care.
• Ensure clinical review processes meet payer deadlines and regulatory guidelines.
• Provide ongoing education to care managers regarding payor-specific authorization processes.
• Maintain patient certification information and communicate status to relevant teams.

Skills

Clinical care experience

Communication

Regulatory awareness

Education

Registered Nurse (RN) license

Job description

UPMC is hiring a full-time Authorization Nurse. The role supports UPMC departments by obtaining referrals and authorizations for admissions, hospital services, and treatments.

You will assess medical necessity using acute care knowledge and payer regulations, ensuring documentation is complete and communicating clinical information to physicians and executives. The position works Monday through Friday with rotating weekends and holidays, daylight hours, and eligibility to work from home.