- CareFirst (Baltimore, MD)
- …for members and providers. Serves as a clinical advisor/leader for teams dedicated to concurrent review , prior authorization , case management, disease ... medical necessity and benefit determinations for medical services (pre-service, concurrent and retrospective), appeals, and medical underwriting. These ensure that… more
- CVS Health (Phoenix, AZ)
- …1+ year varied Utilization Management experience within an Inpatient/Outpatient setting, concurrent review or prior authorization . + 5+ years of variety ... clinical experience required including acute care, home health, or long term care. + 5+ years Demonstrated to make thorough independent decisions using clinical judgement + 5+ Years Proficient use of equipment experience including phone, computer, etc and… more
- Providence (Beaverton, OR)
- …Discharge Planning, Coordination of Outpatient Care) + Utilization Management Experience (EX. Concurrent Review , Prior Authorization , Medical Audits, ... Appeals or Delegation) + Experience working in a health plan, medical insurance plan or another similar work environment + Current nursing experience in the following areas: chronic pain management, cardiology, pediatrics, maternity **Why Join Providence… more
- Providence (WA)
- …Discharge Planning, Coordination of Outpatient Care) + Utilization Management Experience (EX. Concurrent Review , Prior Authorization , Medical Audits, ... Appeals or Delegation) + Experience working in a health plan, medical insurance plan or another similar work environment + Current nursing experience in the following areas: chronic pain management, cardiology, pediatrics, maternity **Why Join Providence… more
- Martin's Point Health Care (Portland, ME)
- …Description Key Outcomes/Results: + Review prior authorization requests ( prior authorization , concurrent review , and retrospective review ... a need for inpatient/ outpatient authorizations. This position receives and reviews prior authorization requests for specific inpatient and outpatient medical… more
- Corewell Health (Grand Rapids, MI)
- …as well as routine audits of staff performance related to concurrent review , discharge planning and prior authorization . + Assists Director with ... Functions + Provides operational management over the Behavioral Health Outpatient Prior Authorization program, Utilization Management, Outpatient Case Management… more
- University of Miami (Miami, FL)
- …Adhere and perform timely prospective review for services requiring prior authorization as well as timely concurrent review for continuation of care ... concurrent and retrospective chart reviews for clinical utilization and authorization . The Utilization Review Case Manager coordinates with the healthcare… more
- Billings Clinic (Billings, MT)
- …insurance/payer policy language, benefits and authorization requirements upon admission, for concurrent review , and for discharge. * Coordinates Peer to Peer ... Processes complete prescription claims including proper adjudication/reconciliation, insurance verification, prior authorization , and compassionate care/medication assistance programs… more
- UPMC (Pittsburgh, PA)
- …current knowledge of regulatory guidelines related to authorizations. + Perform clinical review for cases referred requiring authorization or adherence to payor ... your career? UPMC is looking to hire a full-time Authorization Nurse. This position works Monday through Friday, as...(InterQual). + Ability to apply InterQual criteria appropriately. + Prior utilization review experience. + Knowledge of… more
- Centene Corporation (Sacramento, CA)
- …and healthcare providers, as appropriate, for any discrepancies between prior authorization and concurrent review processes to ensure clinically ... that requires California RN Licensure. **Position Purpose:** Performs a clinical retrospective review of services previously provided to determine if the level of… more
- CVS Health (Phoenix, AZ)
- …Case management and discharge planning experience preferred Discharge planning experience - Utilization review , prior authorization , concurrent review ... , appeals experience - CCM preferred - DSNP experience a plus **Education** Masters Degree in Social Work or Counseling required **Pay Range** The typical pay range for this role is: $54,095.60 - $129,615.20 This pay range represents the base hourly rate or… more
- Centene Corporation (Detroit, MI)
- …to target unique populations + Leadership + Oversees performance of all UM functions ( prior authorization , concurrent review ) for the market per ... the defined partnership agreement*Orchestrates all elements of the population health strategy for the business*Drives HBR initiatives locally through strong partnership and routine with Finance*Partners with MDs to translate the needs of the members into… more
- Centene Corporation (Jefferson City, MO)
- …of the interventions to target unique populations + Oversees performance of all UM functions ( prior authorization , concurrent review ) for the market per ... the defined partnership agreemen + Orchestrates all elements of the population health strategy for the business + Drives HBR initiatives locally through strong partnership and routine with Finance + Partners with MDs to translate the needs of the members into… more
- Billings Clinic (Billings, MT)
- … Review / Management RN. This position is to conduct initial, concurrent , retrospective chart review for clinical financial resource utilization. Coordinates ... hours Ensure order in chart coincides with the payer review , CMS 2 Midnight Rule, or payer authorization...status and level of care Priority 2: Performs Utilization Review (UR) Activities Completes concurrent Level of… more
- Covenant Health Inc. (Louisville, TN)
- …appropriate direction to all departments on issues pertaining to prior authorization , concurrent and retrospective review . + Confers with participating ... Overview Utilization Review Coordinator, Quality Management Full Time, 80 Hours...serves. Position Summary: Reviews information with payors to obtain authorization for payments. Recruiter: Sandra Simmons ||###@covhlth.com|| ### Responsibilities… more
- St. Luke's University Health Network (Allentown, PA)
- …+ Conducts reviews of cases lost with feedback to respective departments + Conduct concurrent review with utilization review department for post op surgical ... patient's ability to pay for health care. The Surgical Review Specialist prospectively reviews, validates, and audits procedure code...prior to discharge, communicate back to PEC for re- authorization , as needed + Is a resource to the… more
- Molina Healthcare (OH)
- …seeking a (RN) Registered Nurse with previous experience in Hospital Acute Care, Concurrent Review / Utilization Review / Utilization Management and knowledge ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
- Scripps Health (San Diego, CA)
- …experience preferred. * Demonstrate knowledge of utilization management including experience managing prior - authorization and concurrent review . * ... Knowledge of Medicare and Commercial health plans. * 3 years of managed care and/or case management experience *Required Education/Experience/Specialized Skills:* * RN 2 plus years clinical experience * 1-2 years inpatient acute hospital case management… more
- Centene Corporation (Raleigh, NC)
- …services to ensure level of care and services are medically appropriate + Performs prior authorization reviews related to mental health and substance abuse to ... medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine… more
- Molina Healthcare (OH)
- …seeking a (RN) Registered Nurse with previous experience in Hospital Acute Care, Concurrent Review / Utilization Review / Utilization Management and knowledge ... responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. + Processes requests within… more