- Equiliem (Orange, CA)
- …of the position such as those listed above may also be qualifying.Preferred Prior authorization / utilization review experience. Managed care experience. ... based on medical necessity criteria. The Care Manager will review and process requests for authorization of...determine medical necessity. Screens requests for the Medical Director's review , gathers pertinent medical information prior to… more
- Conviva (Tallahassee, FL)
- …or customer service telephone experience desired + Experience with Utilization Review and/or Prior Authorization , preferably within a managed care ... Administration Coordinator - Phone Intake contributes to administration of utilization management. The UM Administration Coordinator performs varied activities and… more
- Actalent (Rancho Cordova, CA)
- …file Skills: Utilization review , Case management, Acute care, Prior authorization , Interqual, Concurrent review , Discharge planning, Epic Additional ... and the appropriate application of policies and guidelines to Managed Care prior authorization referral requests. Under general supervision, this position is… more
- CVS Health (Richmond, VA)
- …- 2+ years of managed care experience. - Discharge planning experience preferred. - Utilization review , prior authorization , concurrent review , ... and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. - Monitor… more
- Actalent (Houston, TX)
- …license in Texas. + 2 years of clinical experience with prior authorization and/or utilization review . + Strong understanding of medical terminology, ... Prior Authorization Registered Nurse Remote (Must...currently seeking a highly skilled and motivated Remote Clinical Review Nurse/Concurrent Review Nurse (RN) to join… more
- Centene Corporation (Jefferson City, MO)
- …interactions, and facilitates operations within utilization management. + Manages prior authorization , concurrent review , and retrospective clinical ... benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Manages Prior Authorization , Concurrent Review , and/or Retrospective … more
- Humana (Phoenix, AZ)
- …in Business, Finance or a related field + Experience with Utilization Review and/or Prior Authorization , preferably within a managed care organization ... first** The UM Administration Coordinator 2 contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities… more
- Humana (Madison, WI)
- …experience with medical terminology and/or ICD-10 codes + Experience with Utilization Review and/or Prior Authorization , preferably within a managed care ... first** The UM Administration Coordinator 2 contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities… more
- US Tech Solutions (LA)
- …nursing experience with a minimum of 1 year in utilization management/ prior authorization review experience. **Experience** : Utilization ... a hospital setting in a specialty area of the nursing field providing utilization management prior authorization reviews. Build strong direct relationships… more
- Billings Clinic (Billings, MT)
- …starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! Utilization Review RN Billings Clinic ... - 44.18 Under the direction of department leadership, the Utilization Review / Management RN. This position is...hours Ensure order in chart coincides with the payer review , CMS 2 Midnight Rule, or payer authorization… more
- Kelsey-Seybold Clinic (Pearland, TX)
- … authorization prior to services being rendered for members. The Utilization Review Specialist (LVN) serves as a liaison in reviewing requests for ... **Responsibilities** The Utilization Review Specialist (LVN) is responsible for conducting medical reviews, benefit verification, and applying criteria to… more
- The Arora Group (Bethesda, MD)
- Licensed Practical Nurse (LPN) - Utilization Review Nurse Currently recruiting a Licensed Practical Nurse (LPN/LVN) - Utilization Review in Bethesda, ... required on Federal holidays. DUTIES OF THE LICENSED PRACTICAL NURSE (LPN/LVN) - UTILIZATION REVIEW : + Initiate, perform and complete assigned duties in… more
- University of Miami (Miami, FL)
- …initial, concurrent and retrospective chart reviews for clinical utilization and authorization . The Utilization Review Case Manager coordinates with the ... Utilization Management, has an exciting opportunity for an Utilization Review Case Manager to work remote....advice. CORE FUNCTIONS: + Adhere and perform timely prospective review for services requiring prior authorization… more
- Actalent (Oakland, CA)
- …educate patients and families on treatments. Skills: Social work, utilization review , Insurance verification, Prior authorization Top Skills Details: ... Social work Additional Skills & Qualifications: MSW Experience Level: Intermediate Level About Actalent Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science… 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:** + ... with Medcompass? + Do you have experience with Prior Authorization ? + Do you have experience with Utilization Review ? + Do you have an Active Registered… more
- The Mount Sinai Health System (New York, NY)
- **JOB DESCRIPTION** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program operations ... records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and… more
- Centene Corporation (Springfield, IL)
- …services to ensure level of care and services are medically appropriate + Performs prior authorization reviews related to mental health and substance abuse to ... and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and… more
- St. Luke's University Health Network (Allentown, PA)
- …serve, regardless of a patient's ability to pay for health care. The Network Prior Authorization and Referral Specialist is responsible for the coordination of ... information + Provides insurance company with clinical information necessary to secure prior - authorization or referral + Works in alignment with Central… more
- Molina Healthcare (Riverside, CA)
- …this position we are seeking a LVN (Licensed Vocational Nurse) with experience in Prior Authorizations, Utilization Review / Utilization Management and ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
- Fallon Health (Worcester, MA)
- …+ 3 years' experience, preferably in a managed healthcare environment, with prior authorization and utilization management processes and procedures ... us on Facebook, Twitter and LinkedIn. 3 days in the office ** Prior Authorization experience required** **Brief summary of purpose:** Performs all functions… more
