Medical Necessity Jobs

Tennr is hiring a detail-oriented Quality Assurance Specialist with RCM and DME/HME experience to ensure order accuracy, payer compliance, and reduced denials across our referral workflows.

HealthAxis seeks a detail-oriented Utilization Review Nurse (RN) to conduct medical necessity reviews, manage concurrent inpatient cases, and coordinate with providers using InterQual and evidence-based criteria.

HealthAxis is hiring a part-time Medical Director (Utilization Management) in Tampa to lead clinical review, medical necessity determinations, and UM program improvements for payer clients.

Experienced Utilization Review Specialist needed to manage authorizations, negotiate SCAs, and handle continued stay reviews for a remote behavioral health team serving adolescents.

HealthAxis is hiring a Medical Director of Utilization Management to lead clinical review decisions, ensure regulatory-compliant UM programs, and drive process improvements across payer-facing operations.

Carelon Medical Benefits Management, an Elevance Health company, is hiring a board-certified MD/DO as an Associate Medical Director to provide timely clinical case reviews and medical necessity determinations in radiology and utilization management.

Lead Centene's behavioral health utilization management team in a remote Florida-based Senior Director role focused on clinical quality, policy, operations, and cross-functional leadership.

Humata Health is hiring an Intake Solutions Specialist to manage and process prior authorization requests accurately and efficiently in a remote or hybrid role supporting medical and pharmacy workflows.

Highmark Inc. is hiring a remote Care Management Coordinator in Pennsylvania to handle pre-certification requests, route cases to clinical reviewers, and ensure compliance with regulatory and company standards.

Northwestern Medicine is hiring a Patient Access Specialist to provide accurate patient registration, scheduling, insurance verification, and excellent front-line customer service at the Winfield campus.

The Ohio State University Health Plan is hiring a Registered Nurse Patient Care Resource Manager to perform retrospective claims reviews, support utilization management, and contribute to clinical policy and process improvements for its member population.

EVERSANA is hiring a Healthcare Call Center Specialist to deliver benefit verification, prior authorization support, and payer triage for patients, HCPs, and payers in a fast‑paced clinical support environment.