- Peoples Home Health, LLC (Pensacola, FL)
- …insurance policy benefits to accurately reflect coverage amounts and Client co-pay ( prior approval of insurance authorization ). The Intake Specialist must be ... Identifies insurance carriers and verifies benefits and eligibility. Collaborates with CTM/Case Manager on authorized visit to assure accurate utilization for… more
- CVS Health (Baton Rouge, LA)
- …with heart, each and every day. **Position Summary** The Utilization Management Manager of Prior Authorization oversees a team of clinical professionals ... + Lead, coach, and develop a multidisciplinary team responsible for utilization review, prior authorization , and case management functions. + Monitor team… 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 ... Operations has an exciting opportunity for a full time Utilization Review Case Manager to work to...Adhere and perform timely prospective review for services requiring prior authorization as well as timely concurrent… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a* Utilization Review Manager * to join ourTransitional Care Team.This is a full-time role and will be required to work ... ) required or completed within three years of hire **Title:** * Manager - Utilization Review* **Location:** *MN-Minneapolis-Downtown Campus* **Requisition ID:**… more
- Fallon Health (Worcester, MA)
- …Registered Nurse in a clinical setting required. * 2 years' experience as a Utilization Management/ Prior Authorization nurse in a managed care payer ... **This is 3 months temporary contract position for a Prior Authorization RN.** **About us:** Fallon Health...Keeps records and submits reports as assigned by the Manager * Refers high-risk cases to the appropriate FH… more
- University of Rochester (Rochester, NY)
- …activities as defined by NYS Laws and Regulations. The Pharmacy Medication Utilization and Inventory Compliance Manager has direct supervision and management ... medication inventory management locations, and is intended to be a 'line manager ' level of responsibility, covering shifts typical of their team while utilizing… more
- Elevance Health (Seven Hills, OH)
- …**Build the Possibilities. Make an Extraordinary Impact.** **Title** : Clinical Pharmacist ( Prior Authorization ) **Location(s):** + Indianapolis, IN + Mason, OH ... law._** The **Clinical Pharmacist** is responsible for managing the selection and utilization of pharmaceuticals and supports core clinical programs such as DUR, DIS… more
- Elevance Health (Las Vegas, NV)
- … Management Representative II** is responsible for coordinating precertification and prior authorization reviews in both governmental and commercial business ... ** Utilization Management Representative II** **Location** : This role...provides authorization for inpatient admission, outpatient precertification, prior authorization , and post service requests. +… more
- Elevance Health (Tampa, FL)
- … Management Representative I** is responsible for coordinating cases for precertification and prior authorization review. **How you will make an impact:** + ... ** Utilization Management Representative I** **Location** : This role...provides authorization for inpatient admission, outpatient precertification, prior authorization , and post service requests. +… more
- Elevance Health (Costa Mesa, CA)
- … Management Representative I** is responsible for coordinating cases for precertification and prior authorization review. **How you will make an impact:** + ... ** Utilization Management Representative I** **Location** : This role...provides authorization for inpatient admission, outpatient precertification, prior authorization , and post service requests. +… more
- Elevance Health (Louisville, KY)
- …Management Representative I** will be responsible for coordinating cases for precertification and prior authorization review. **How you will make an impact:** + ... ** Utilization Management Representative I** **Virtual:** This role enables...provides authorization for inpatient admission, outpatient precertification, prior authorization , and post service requests. +… more
- Elevance Health (West Des Moines, IA)
- …eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization , and post service requests. + Obtains intake ... ** Utilization Management Representative II** **Location:** The selected candidate...to screen basic and complex requests for precertification and/or prior authorization . + Verifies benefits and/or eligibility… more
- Elevance Health (Columbus, GA)
- … Management Representative III** is responsible for coordinating cases for precertification and prior authorization review. **How you will make an impact:** + ... ** Utilization Management Representative III** **Virtual:** This role enables...contract and benefit eligibility for requested continuing pre-certification and prior authorization of inpatient and outpatient services… more
- LA Care Health Plan (Los Angeles, CA)
- …Preferred: Experience in Medi-Cal managed care. 1 year of experience in UM/ Prior Authorization . Skills Required: Demonstrated proficiency in Medical Terminology ... Authorization Technician II (ALD) Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time… more
- Healthfirst (NY)
- …leadership to UM leaders and teams executing department functions including prior authorizations, concurrent reviews, and service requests + Develop strong ... to maintain and improve department performance + Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement + Lead… more
- Henry Ford Health System (Troy, MI)
- …processing system, development of new benefit designs and programs, organizing the prior authorization process and management of the various vendor/customer ... GENERAL SUMMARY: Reports to the Manager of Pharmacy Benefits and other delegated pharmacist....Additional Information + Organization: Community Care Services + Department: Pharmacy- Utilization Mgmt + Shift: Day Job + Union Code:… more
- UNC Health Care (Goldsboro, NC)
- …6. Escalate matters/scheduled accounts that require attention to Pre-Arrival Team Lead/ Manager . 7. Notify Utilization Review & Case Management regarding ... **Description** Summary: The Pre- Arrival Authorization Specialist I will serve patients/customers and physician...and physician offices by obtaining authorizations from insurance payers prior to services being scheduled or rendered at UNC… more
- Sharp HealthCare (San Diego, CA)
- …referrals for care and services are directed to appropriate network providers, and obtains prior authorization for in network and out of network services as ... Day **FTE** 1 **Shift Start Time** **Shift End Time** Accredited Case Manager (ACM) - American Case Management Association (ACMA); Bachelor's Degree in Nursing;… more
- Sharp HealthCare (San Diego, CA)
- …referrals for care and services are directed to appropriate network providers, and obtains prior authorization for in network and out of network services as ... **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered… more
- Commonwealth of Pennsylvania (PA)
- Nurse Manager 1 (1st shift) - South Mountain Restoration Center Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/5166390) Apply Nurse ... Manager 1 (1st shift) - South Mountain Restoration Center...developmental disability. Special Requirements: + This position requires active authorization to practice as a Registered Nurse in Pennsylvania.… more
