Remote RN: Medical Management & Prior Authorization

Banner Health; United States; Remote; USD 48,000 - 81,000; Full time

Job summary

Banner Health is seeking an RN for Medical Management Services to influence care and support prior authorization decisions remotely. You will research plans using CMS, Noridian, and Encoder Pro tools, handling pre-service reviews and case management with meticulous documentation.

The ideal candidate holds an RN license, a bachelor's degree (or equivalent experience), and at least five years of clinical practice, with strong collaboration skills across teams.

Qualifications

• Active RN license in the practicing state with exp in care management.
• Bachelor's degree or equivalent clinical experience required.
• Minimum five years of clinical experience.

Responsibilities

• Support and execute programs to influence provider and member behaviors.
• Process pre-service and concurrent review determinations.
• Perform care coordination and utilization management duties.
• Communicate with providers, vendors, and members per Banner processes.
• Document interventions accurately in medical records.

Skills

RN licensure

Bachelor’s degree

Five years clinical exp

Care management

Effective communication

Education

Bachelor’s degree or equivalent experience

RN licensure

Tools

CMS

Noridian

Encoder Pro

Job description

Banner Health is seeking an RN for Medical Management Services to influence care and support prior authorization decisions remotely. You will research plans using CMS, Noridian, and Encoder Pro tools, handling pre-service reviews and case management with meticulous documentation.

The ideal candidate holds an RN license, a bachelor's degree (or equivalent experience), and at least five years of clinical practice, with strong collaboration skills across teams.