Top 298 Precertification Nurse Jobs

Med Mgmt Clinician (contract)
Elevance Health —Remote
- $25.44 - $48.58 an hour
- Contract
- Remote
- LVN
- RN License
- Mid-level
- Health savings account
- Disability insurance
Precertification Nurse-LPN/RN (Remote in NJ/PA)
MEDLOGIX, LLC —Township of Hamilton, NJ
- $28 - $32 an hour
- Full-time
- Remote
- Nursing
- RN License
- English
Quick Apply
Precertification & Pre-Service Appeals Nurse
CURE Auto Insurance —Princeton, NJ
- $65,000 - $85,000 a year
- Hybrid work
- Nursing
- RN License
- Writing skills
- Health savings account
- AD&D insurance
Quick Apply
Clinical Reviewer Nurse
Integrated Home Care Acquisition —Miramar, FL
- RN License
- Word processing
- Mid-level
- Paid training
- Wellness program
Quick Apply
Case Management Nurse - Oncology or Transplant Experience
Innovative Care Management, Inc. —Arizona
- Full-time
- Remote
- Background check
- Nursing
- RN License
- Health insurance
Care Management RN
Uniontown Hospital —Uniontown, PA
- Full-time
- Nursing
- RN License
- Hospital
RN CLINICAL CASE MANAGER
Legent Health —Bellaire, TX
- Full-time
- Nursing
- Mid-level
- US work authorization
- Paid time off
Quick Apply
Case Management Nurse - Oncology or Transplant Experience
Innovative Care Management, Inc. —Idaho
- Full-time
- Remote
- Nursing
- RN License
- 5 years
- Health insurance
Home Health Clinical Manager
First Call Home Health —Salem, OR
- From $125,000 a year
- Full-time
- Background check
- CPR Certification
- Nursing
- Mileage reimbursement
- Health savings account
Quick Apply
9d
Case Management Nurse - Oncology or Transplant Experience
Innovative Care Management, Inc. —Iowa
- Full-time
- Nursing
- RN License
- 5 years
- Health insurance
Utilization Review Coordinator
Neuropsychiatric Hospitals —Huber Heights, OH
- Full-time
- Nursing
- Psychiatry
- Mid-level
- Health insurance
- Dental insurance
Registered Nurse Case Manager ED Full Time Nights
Martin Luther King, Jr. Community Hospital —Los Angeles, CA
- $53.07 - $82.27 an hour
- Full-time
- Background check
- Spanish
- Nursing
- Wellness program
- 403(b) matching
Quick Apply
Clinical Manager - Home Health Registered Nurse
Amedisys —Largo, MD
- $116,000 - $120,000 a year
- Full-time
- CPR Certification
- Nursing
- RN License
- Mileage reimbursement
- Paid parental leave
RN Home Health Clinical Manager
Amedisys —Portland, OR
- $115,000 - $122,000 a year
- Full-time
- CPR Certification
- Nursing
- RN License
- Mileage reimbursement
- Paid parental leave
RN Clinical Manager Hospice
Amedisys —Bangor, ME
- $90,000 - $92,000 a year
- Full-time
- CPR Certification
- Nursing
- RN License
- Travel reimbursement
- Wellness program
Quick Apply
7d
Registered Nurse RN Clinical Manager
Amedisys —Sherman, TX
- $75,000 - $80,000 a year
- Full-time
- CPR Certification
- Nursing
- RN License
- Mileage reimbursement
- Paid parental leave
RN Clinical Manager
Amedisys —Kingstree, SC
- $72,000 - $82,000 a year
- Full-time
- CPR Certification
- Nursing
- RN License
- Mileage reimbursement
- Paid parental leave
7d
RN Clinical Manager Home Health
Amedisys —Greenville, SC
- $70,000 - $80,000 a year
- Full-time
- CPR Certification
- Nursing
- RN License
- Mileage reimbursement
- Paid parental leave
8d
RN Clinical Manager
Amedisys —Yuma, AZ
- $85,000 - $107,472 a year
- Full-time
- CPR Certification
- Nursing
- RN License
- Mileage reimbursement
- Paid parental leave
RN Clinical Manager
Amedisys —Metairie, LA
- $85,000 - $90,000 a year
- Full-time
- CPR Certification
- Nursing
- RN License
- Mileage reimbursement
- Paid parental leave
14d

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Med Mgmt Clinician (contract)

Elevance Health -
Remote

Apply Now

Job Details

Contract
$25.44 - $48.58 an hour

Benefits

Health savings account
Disability insurance
Health insurance
Dental insurance
401(k)
Vision insurance
Life insurance

Qualifications

Contract review
LVN
RN License
Health insurance plan information
Mid-level
Pre-authorization review for utilization management
Utilization management
Concurrent review in utilization management
LPN
4 years
Nurse Licensure Compact (NLC)

Full Job Description

Job ID: JP46530

Anticipated Start Date: May 25, 2026

Please note this is the target date and is subject to change. BCForward will send official notice ahead of a confirmed start date.

Primary duties may include, but are not limited to:

Responsible for moderately complex cases that may require evaluation of multiple variables against guidelines when procedures are not clear.
Work may be facilitated, in part, by algorithmic or automated processes.
Handles moderately complex benefit plans and/or contracts.
Works on reviews that may require guidance by more senior colleagues and/or management.
May serve as a resource to less experienced staff.
Conducts and may approve precertification, concurrent, retrospective, out-of-network, and/or appropriateness of treatment setting reviews by assessing clinical information against appropriate medical policies, clinical guidelines, and the relevant benefit plan/contract.
May process a medical necessity denial determination made by a Medical Director.
May work directly with healthcare providers to obtain and understand clinical information.
Refers complex or unclear reviews to higher level nurses and/or Medical Directors.
May educate members about plan benefits and physicians.
Does not issue medical necessity non-certifications.

Requirements:

Requires a minimum of 4 years of clinical experience and/or utilization review experience.
Current active, valid and unrestricted LPN/LVN license or RN license and/or certification to practice as a health professional within the scope of licensure in applicable state(s) or territory of the United States required.
Multi-state licensure is required if this individual is providing services in multiple states.

Job Type: Contract

Additional Details:

8AM - 5PM EST, Monday - Friday.
Virtual (work from home)

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, contractors are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

About BCForward:

Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.

BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.

BCForward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.

To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.

This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.

Pay Rate Range

25.44 - 48.58 USD hourly

Additional Notes

The pay range is the range BCForward in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations.

Benefits Information

BCForward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.

The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. This does not encompass additional non-standard compensation (e.g., benefits, paid time off, per diem, etc.).

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

Apply Now

Refine Your Search

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Med Mgmt Clinician (contract)

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Home Health Clinical Manager

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RN Clinical Manager Home Health

RN Clinical Manager

RN Clinical Manager

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