The Judge Group

Compensation

Full Description

Location: MUST reside in NJ, PA, NY, CT, or MD Schedule: Mon–Fri, 8 AM–5 PM EST Work Setup: Remote, with first and last day in office Training: 2 weeks, including mentorship and case work Caseload: 10–35 cases/day, based on demand Role Overview As a Prior Authorization RN, you'll ensure patients receive timely, medically appropriate, and cost-effective care. You’ll assess clinical needs, coordinate care plans, and advocate for members across the healthcare continuum. Key Responsibilities • Review inpatient stays and services for medical necessity • Coordinate care plans across internal and external providers • Monitor quality and cost-effectiveness of care delivery • Advocate for patients and families across care settings • Refer members to case/disease management programs • Document accurately and communicate with care teams • Promote self-care while managing resource utilization ✅ Qualifications • Reside in NJ, PA, NY, CT, or MD • Active NJ or Compact RN license • 3+ years clinical RN experience • 2+ years in Prior Authorization at a health plan • Proficient in Microsoft Office and Windows-based tools • Knowledge of hospital systems and payment structures • Strong understanding of care/case/disease management By providing your phone number, you consent to: (1) receive automated text messages and calls from the Judge Group, Inc. and its affiliates (collectively "Judge") to such phone number regarding job opportunities, your job application, and for other related purposes. Message & data rates apply and message frequency may vary. Consistent with Judge's Privacy Policy, information obtained from your consent will not be shared with third parties for marketing/promotional purposes. Reply STOP to opt out of receiving telephone calls and text messages from Judge and HELP for help.