Medical Necessity Jobs

Dane Street is recruiting board-certified Interventional and Diagnostic Radiologists to perform remote, per-case medical necessity reviews and appeal determinations on a flexible contract basis.

Emory Healthcare is hiring a Clinical Liaison — a licensed clinician who drives referrals and admissions to acute rehab by performing preadmission assessments, coordinating care, and cultivating strong referral relationships.

Experienced RN with utilization management and prior authorization expertise needed to validate and improve AI-driven prior authorization workflows at Innovaccer.

Centinela Hospital Medical Center is hiring an RN Case Manager to coordinate inpatient care, perform concurrent review for medical necessity, and support cost-effective, high-quality patient outcomes.

An Insurance Verification and Prior Authorization Specialist is needed at USA Clinics Group's Northbrook corporate office to manage high-volume authorizations, denials, and referral coordination for outpatient procedures.

Northwestern Medicine is hiring an on-site Utilization Reviewer for Behavioral Health Services to manage precertification, continued stay reviews, discharge planning communication, and insurer appeals.

Humata Health is hiring an RN with utilization management experience to help digitize payer policies, validate AI-driven prior authorization workflows, and coordinate cross-functional projects.

Giving Home Health Care seeks a detail-oriented Medical Necessity Writer Specialist in Albuquerque to prepare medical documentation, evaluate records for benefits eligibility, and support patients through the claims process.

American Specialty Health is hiring a licensed, experienced acupuncturist to serve remotely as Manager I — CQE Acupuncture, conducting medical necessity reviews and supporting clinical quality and credentialing activities.

Experienced, Board-Certified Orthopedic Spine Surgeons with active Texas licenses are needed to perform independent record reviews, counter-affidavits, and expert witness services on a per-case 1099 contract basis.

CVS Health is hiring a remote Utilization Management Nurse Consultant (Behavioral Health) to conduct clinical reviews, manage prior authorizations, and apply evidence-based criteria for behavioral health and substance abuse services.

Dane Street is recruiting Texas-licensed, board-certified neurologists to provide contract physician-reviewer services for contra-affidavit work, IME support, and expert testimony.

Experienced licensed psychologist needed to perform medical necessity reviews, appeals, and peer-to-peer consultations for Telligen’s managed care contracts on a part-time 1099 basis.

Sutter Health is hiring a Physician Advisor to lead utilization review, support clinical documentation improvement, and guide level-of-care decisions at its Sacramento facility.

Experienced LVN/RN with utilization review background needed to perform clinical reviews, determine medical necessity, and collaborate with providers and case teams in a remote Utilization Management Nurse Reviewer role at Dane Street.

Experienced, board-certified physician needed to lead Utilization Management strategy and clinical operations at Wellmark, driving evidence-based UM decisions, team development, and cross-functional initiatives to reduce overuse and improve quality.

Experienced board-certified Diagnostic Radiology physicians are needed to provide objective medical necessity reviews and advisory opinions for IMEs and utilization review on a flexible, per-case basis.

Dane Street is hiring a board-certified Hematology/Oncology physician to perform IME reviews and advisory services, providing objective, evidence-based determinations for insurance appeals and claims reviews.

Experienced, board-certified cardiologist needed to perform independent medical exams and medical necessity reviews on a flexible, remote contract basis.

Wellmark is looking for a detail-oriented Utilization Management Nurse to conduct prior authorizations, utilization reviews, and care coordination for members while supporting timely discharge planning and medical necessity determinations.

Experienced nurses are sought to manage utilization reviews and prior authorizations remotely for Presbyterian Healthcare Services, ensuring clinical appropriateness, timely authorizations, and quality audit oversight for Albuquerque-area members.

Garden Grove Hospital Medical Center is hiring a Medical Review Coordinator to perform clinical record reviews and coordinate utilization review and case management to ensure appropriate, compliant patient care and documentation.

Northwestern Medicine is hiring an experienced Registered Nurse to remotely manage outpatient orders, ensure medical necessity and regulatory compliance, and support physician offices and clinical teams.

Utilization Review Specialist / RN at Emory Healthcare responsible for comprehensive patient care reviews ensuring appropriate utilization and compliance in a remote work setting.