- Alameda Health System (San Leandro, CA)
- Clinical Nurse III, Acute Inpatient Behavioral Health Utilization Management + San Leandro, CA + John George Psychiatric Hospital + JGP Care Coordination + Services ... Behavioral Health Department Alameda County Utilization Review Plan to obtain authorization of acute inpatient services. Provides medical necessity and patient Care… more
- Luke Staffing (Yigo, GU)
- ** NURSE - REFERRAL MANAGEMENT** **SITE OF SERVICE:** Andersen Air Force Base, Guam **POSITION QUALIFICATION/REQUIREMENTS:** + **Education:** Vocational Nurse ... unrestricted license to practice as a Practical OR Registered Nurse in any one of the 50 States, the...Line of Duty paperwork is on file prior to authorization . + Verify eligibility of beneficiaries using Defense Eligibility… more
- Tidelands Health (Murrells Inlet, SC)
- …Tidelands and help people live better lives through better health!** **Outpatient Nurse (RN)** Are you passionate about quality and committed to excellence? Consider ... bring our healing mission to life each day. **A Brief Overview** The Outpatient Nurse (RN) is responsible for the provision of nursing care based on standards of… more
- Commonwealth Care Alliance (Boston, MA)
- …and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets CMS ... Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer is responsible for day-to-day timely… more
- beBeeLicensed (San Angelo, TX)
- …experience in nursing is preferred. xrbllit Certification/Licensure: Requires a Licensed Vocational Nurse (LVN), with Authorization to Practice in the State of ... for this position. As a skilled healthcare professional, the Licensed Vocational Nurse will deliver high-quality patient care and support in a dynamic medical… more
- Stony Brook University (Stony Brook, NY)
- …placed in the correct level of care from initial assess point. Follows cases for authorization for in patient stay. + Staff review short stay, long stay and complex ... with the transferring hospital, Patient Access and physicians and payers for authorization prior to transfer from other hospitals. + Consistent documentation in the… more
- Highland Hospital (Rochester, NY)
- …unavailable + Complete clinical documentation, forms/paperwork requested by patients, prior authorization appeals, sign home care orders + Coordinate with other ... Requirements:** 1. Education: Fulfills the requirements to be licensed as a Nurse Practitioner in NYS 2. Experience: Home care, hospice/palliative care, inpatient… more
- Argonne National Laboratory (Lemont, IL)
- …an experienced physician medical director and two seasoned nurse practitioners, delivering injury/illness care, medical surveillance, return-to-work evaluations, ... the future) for the individual be to obtain a government access authorization that involves additional background check requirements. Failure to obtain or maintain… more
- Stanford Health Care (Palo Alto, CA)
- …+ Knowledge of medical management statistics relating to UM/CM and prior authorization process management. + Extensive knowledge of risk stratification methods and ... and make recommendations for improvement. **Licenses and Certifications** + Nursing\RN - Registered Nurse - State Licensure And/Or Compact State Licensure . + CCM -… more
- Cordis (Irvine, CA)
- …experience with cardiovascular procedures in clinical research in this same role or as a nurse or tech as radiology tech or Cath lab tech + Minimum 3 years' ... depending on skills, education, experience, job-related knowledge and location. US work authorization is a precondition of employment. The company will not consider… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- …advocates on behalf of Members and families for out-of-network authorization approvalsImplement: Identifies problems, barriers, and opportunities within processes ... to establish the most appropriate course of action + Provides education to nurse and therapist reviewers regarding appeal updates and process changes + Maintains… more
- UCLA Health (Los Angeles, CA)
- …prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards, and established guidelines to determine ... Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role in ensuring the delivery of high-quality, evidence-based care. This… more
- Fallon Health (Worcester, MA)
- …in a clinical setting required. * 2 years' experience as a Utilization Management/Prior Authorization nurse in a managed care payer preferred. * One year ... is 3 months temporary contract position for a Prior Authorization RN.** **About us:** Fallon Health is a company...Twitter and LinkedIn. **Brief summary of purpose:** The PA Nurse uses a multidisciplinary approach to review service requests… more
- US Tech Solutions (May, OK)
- …prior authorizations following policy and procedure. + * Provide on-call after hours nurse availability for urgent PA requests. + * Provide internal nurse ... healthcare professionals and members. + * Follow all prior authorization procedures to guarantee an accurate process on each...by the PA leadership team. **Education:** **The Licensed Practical Nurse is a graduate of a school of Practical… more
- US Tech Solutions (LA)
- **Position Summary:** As a Prior Authorization Nurse , you work outside the walls of a hospital setting in a specialty area of the nursing field providing ... utilization management prior authorization reviews. Build strong direct relationships with providers and...indicated by staffing and business needs. **Duties:** + **Registered Nurse with current license in LA state of employment.… more
- US Tech Solutions (May, OK)
- …prior authorizations following policy and procedure. + Provide on-call after hours nurse availability for urgent PA requests. + Provide internal nurse ... other clinical colleagues, healthcare professionals and members. + Follow all prior authorization procedures to guarantee an accurate process on each prior … more
- CVS Health (Baton Rouge, LA)
- …with heart, each and every day. **Position Summary** The Utilization Management Nurse Consultant (UMNC) for Prior Authorization conducts high-acuity, timely, and ... compliance and organizational goals. Key Responsibilities: * Perform prior authorization clinical reviews of acute admissions using evidence-based criteria (eg,… more
- Roper St. Francis (Ladson, SC)
- …accommodation. **Licensing/Certification** + New grad RNs with a BON temporary work authorization must obtain Registered Nurse license within 90 days of ... new opportunities arise._ **Primary Function/General Purpose of Position** The Registered Nurse 's primary function is to plan, provide, supervise, and coordinate… more
- Roper St. Francis (Ladson, SC)
- …experience is desired. **Licensure/Certification:** New grad RNs with a BON temporary work authorization must obtain Registered Nurse license within 90 days of ... different territory as new opportunities arise._ **Job Summary** **:** The Registered Nurse 's primary function is to plan, provide, supervise and coordinate care to… more
- Roper St. Francis (Ladson, SC)
- …accommodation. **Licensing/Certification** + New grad RNs with a BON temporary work authorization must obtain Registered Nurse license within 90 days of ... new opportunities arise._ **Primary Function/General Purpose of Position** The Registered Nurse 's primary function is to plan, provide, supervise, and coordinate… more
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