- Altru Health (East Grand Forks, MN)
- …and participating in restructuring of current and new programs. Performs utilization review when required. Collaborates with Primary Care Provider (PCP) regarding ... | North Dakota Board of Social Work Examiners | Prior to Start Date | HR Primary Sources Licensed...(LPCC) | North Dakota Board of Counselor Examiners | Prior to Start Date | HR Primary Sources Licensed… more
- Adecco US, Inc. (Minneapolis, MN)
- …LVN/LPN license in State of Residence * 2+ years of care management, utilization review ( prior authorization) or discharge planning experience **Why work for ... Adecco Healthcare & Life Sciences is hiring for a ** Utilization Management** **LPN** to work **remotely** ! This is...**Location:** Remote / work from home **Responsibilities of the Utilization Management LPN:** * In collaboration with the Manager… more
- Centene Corporation (Madison, WI)
- …related to member care, provider interactions, and facilitates operations within utilization management. + Manages prior authorization, concurrent review, and ... a fresh perspective on workplace flexibility. **Position Purpose:** Manages Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team… more
- Trinity Health (Silver Spring, MD)
- …private service organizational activities relating to discharge planning and resource utilization . Evidence of prior successful interaction with external review ... Full time **Shift:** **Description:** The Interim Manager of Care Management & Utilization Review, under the supervision and in collaboration with the Director, is… more
- CVS Health (Phoenix, AZ)
- …and external constituents in the coordination and administration of the utilization /benefit management function + Performs prior authorization reviews related ... working in the Arizona Medicaid Health system + Managed care experience + Utilization review experience + Prior authorization experience + Claims review… more
- CVS Health (Salt Lake City, UT)
- …**Preferred Qualifications** + Direct clinical experience in a hospital setting or prior Utilization Management experience. **Education** + If RN, Bachelor's ... skills to coordinate, document and communicate all aspects of the utilization /benefit management program for preauthorization for mental health services. Applies… more
- US Tech Solutions (Chicago, IL)
- …as an RN + Registered Nurse in state of residence + Must have prior authorization utilization experience + Experience with Medcompass **Skills:** + MUST HAVE ... and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review. + MUST HAVE 1 YEAR OF...Prior Authorization? + Do you have experience with Utilization Review? + Do you have an Active Registered… more
- CVS Health (Richmond, VA)
- …shift up to 8:00pm EST zone (twice per month) **Preferred Qualifications** + Prior Authorization or Utilization Management experience + Managed care experience + ... opportunities to promote quality effectiveness of Healthcare Services and benefit utilization + Consults and lends expertise to other internal and external… more
- US Tech Solutions (May, OK)
- …inpatient hospital experience . Registered Nurse in state of residence . Must have prior authorization utilization experience . Able to work in multiple IT ... and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review. . MUST HAVE 1 YEAR OF...knowledge of Milliman/MCG. . MUST HAVE 6 months of Prior Authorization. Education: . Active and unrestricted RN licensure… more
- Sanford Health (ND)
- …28.00 **Department Details** Opportunity to work remotely. **Job Summary** Monitors the utilization of resources, risk management and quality of care for patients in ... accordance to established guidelines and criteria for designated setting and status. Collection of clinical information necessary to initiate commercial payor authorization. Obtain and maintain appropriate documentation concerning services in accordance to… more
- Katmai (Usaf Academy, CO)
- …of Science in Nursing (BSN) is required. + Minimum of two (2) years of prior experience in Utilization Management. + Must possess a current, active, full, and ... checks. **DESIRED QUALIFICATIONS &** **SKILLS** + Certification by a Utilization Management-specific program such as Certified Professional in Healthcare Management… more
- Molina Healthcare (San Bernardino, CA)
- …Experience** 3-5 years clinical practice with managed care, hospital nursing or utilization management experience. Previous experience in Prior Auth ... _JOB TITLE: CARE REVIEW CLINICIAN, PRIOR AUTHORIZATION (REGISTERED NURSE, OR LVN)_ **JOB DESCRIPTION** **Job Summary** Molina Healthcare Services (HCS) works with… more
- Molina Healthcare (IA)
- …or ER unit. _with previous experience in hospital acute care, Inpatient Review, Prior Authorizations, Utilization Review / Utilization Management and ... and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare… more
- Molina Healthcare (UT)
- …position we are seeking a (RN) Registered Nurse, with previous experience in Prior Authorizations, Utilization Review / Utilization Management and knowledge ... and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare… more
- Premier Health (Dayton, OH)
- … Prior job title or occupational experience: Case management, Utilization review Prior specific functional responsibilities: N/A Preferred experience: ... with knowledge and expertise in process analysis, clinical outcome data analysis, utilization management, and utilization of information systems. The DMCA is… more
- Walmart (Bentonville, AR)
- …management with the successful design, execution, and scaling of new concepts/ innovations. Prior work experience in data utilization . Prior work experience ... minimum qualifications. Master's degree in public health, business, other related area. Prior work experience with a sustained record of productivity at the… more
- US Tech Solutions (LA)
- …a hospital setting in a specialty area of the nursing field providing utilization management prior authorization reviews. Build strong direct relationships with ... + Minimum 3 years nursing experience with a minimum of 1 year in utilization management/ prior authorization review experience. **Experience** : Utilization … more
- Molina Healthcare (Waltham, MA)
- …performing one or more of the following activities: care review/ utilization management ( prior authorizations, inpatient/outpatient medical necessity, etc.), ... Collates and reports on Care Access and Monitoring statistics including plan utilization , staff productivity, cost effective utilization of services, management… more
- CareFirst (Baltimore, MD)
- …President, Health Services, this position leads and oversees Case Management, Utilization Management including prior authorization, and post service clinical ... health and medical care management at all stages of the health continuum, utilization management decisions themselves and the consequences of those decisions by way… more
- Elevance Health (Hermitage, PA)
- …with facility-based and/or outpatient psychiatric and chemical dependency treatment and prior utilization management experience, which includes a minimum of ... **Manager II Behavioral Health Services** will be responsible for Behavioral Health Utilization Management (BH UM), or Behavioral Health Case Management (BH CM) or… more
