- Luke Staffing (Yigo, GU)
- ** NURSE - REFERRAL MANAGEMENT** **SITE OF SERVICE:** Andersen...+ Ensures Line of Duty paperwork is on file prior to authorization . + Verify eligibility of ... Air Force Base, Guam **POSITION QUALIFICATION/REQUIREMENTS:** + **Education:** Vocational Nurse Program OR Baccalaureate of Science in Nursing Program from an… more
- Commonwealth Care Alliance (Boston, MA)
- …Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical areas, including but ... **Required Knowledge, Skills & Abilities (must have):** + Experience with prior authorization and retrospective reviews + Proficiency reviewing clinical/medical… 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
- Stony Brook University (Stony Brook, NY)
- …with the transferring hospital, Patient Access and physicians and payers for authorization prior to transfer from other hospitals. + Consistent documentation ... of care from initial assess point. Follows cases for authorization for in patient stay. + Staff review short...required. **Qualifications** **Required** : A Bachelor's degree or a nurse working on their degree with an RN license… more
- Highland Hospital (Rochester, NY)
- …who is unavailable + Complete clinical documentation, forms/paperwork requested by patients, prior authorization appeals, sign home care orders + Coordinate with ... Requirements:** 1. Education: Fulfills the requirements to be licensed as a Nurse Practitioner in NYS 2. Experience: Home care, hospice/palliative care, inpatient… more
- Stanford Health Care (Palo Alto, CA)
- …ASA + Knowledge of medical management statistics relating to UM/CM and prior authorization process management. + Extensive knowledge of risk stratification ... 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' ... experience working directly with physicians and healthcare professionals + Prior experience with clinical trials (preferred) + Experience in coronary or peripheral… more
- UCLA Health (Los Angeles, CA)
- …This position is responsible for reviewing and evaluating clinical documentation related to prior authorization requests for medical services. The UM Review ... efficient utilization of resources. Key Responsibilities: + Conducts clinical reviews of prior authorization requests to evaluate medical necessity and benefit… more
- Fallon Health (Worcester, MA)
- …Nurse in a clinical setting required. * 2 years' experience as a Utilization Management/ Prior Authorization nurse in a managed care payer preferred. * One ... **This is 3 months temporary contract position for a Prior Authorization RN.** **About us:** Fallon Health...Twitter and LinkedIn. **Brief summary of purpose:** The PA Nurse uses a multidisciplinary approach to review service requests… more
- US Tech Solutions (May, OK)
- …other clinical colleagues, healthcare professionals and members. + * Follow all prior authorization procedures to guarantee an accurate process on each ... policy and procedure. + * Provide on-call after hours nurse availability for urgent PA requests. + * Provide... prior authorization . + * Train and mentor... prior authorization . + * Train and mentor representatives on the… more
- US Tech Solutions (May, OK)
- …pharmacists, other clinical colleagues, healthcare professionals and members. + Follow all prior authorization procedures to guarantee an accurate process on ... following policy and procedure. + Provide on-call after hours nurse availability for urgent PA requests. + Provide internal...each prior authorization . + Train and mentor representatives… 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...indicated by staffing and business needs. **Duties:** + **Registered Nurse with current license in LA state of employment.… more
- CVS Health (Baton Rouge, LA)
- …all with heart, each and every day. **Position Summary** The Utilization Management Nurse Consultant (UMNC) for Prior Authorization conducts high-acuity, ... supporting regulatory compliance and organizational goals. Key Responsibilities: * Perform prior authorization clinical reviews of acute admissions using… more
- AssistRx (Orlando, FL)
- …support programs. + Familiarity with PSP workflows: hub services, copay programs, prior authorization , benefits investigations, nurse support. + Strong ... treatment. Our suite of solutions-including iAssist(R), Hub Lite (TM) , Prior Authorization , Benefits Verification, Copay Support, specialty pharmacy… more
- CVS Health (Baton Rouge, LA)
- …Screening, Diagnostic, and Treatment (EPSDT) case managers, providers, and enrollees on prior authorization requests for services. The UM Coordinator will ... days of the scheduled appointment * Assists with problems on each prior authorization requests, including identification of new providers, notification to… more
- Hartford HealthCare (Farmington, CT)
- …on billing and authorization processes.* * *Assists with training of new prior authorization staff and other duties as assigned.* *At Hartford HealthCare, we ... based on eligibility.* *Job Summary: Under the direction of the Prebilling and Authorization Manager, the Authorization Specialist performs all duties related to… more
- Aspirus Ironwood Hospital (Wausau, WI)
- …WI is seeking an AUTHORIZATION SPECIALIST to join our team! The Authorization Specialist is critical to ensure accurate prior and ongoing authorizations. ... and communication with the patients, clinical team including physicians, nurse practitioners, patient navigator, pharmacy staff, and patient financial services… more
- Trinity Health (Syracuse, NY)
- …This role focuses on monitoring expirations of referrals, verifying insurance updates prior to procedure, and supporting authorization and denial processes. ... Technician (or eligible), Registered Record Administrator (or eligible) or Licensed Practical Nurse (LPN) with a minimum of 5 years' experience in an appropriate… more
- MD Anderson Cancer Center (Houston, TX)
- …an Advanced Practice Registered Nurse from the Texas State Board of Nursing prior to 1/1/2003. * : Graduate education and related Texas Board of Nursing ... Pract. Upon Hire or * Required: APNPAdv Pract Nurse /Prescriptive Upon Hire or * Required: Related authorization... Nurse /Prescriptive Upon Hire or * Required: Related authorization must be consistent with clinical practice area and… more
- US Tech Solutions (GA)
- …from distractions. You will provide processing and communication of specialty medication prior authorization (PA) requests reviewed by the Specialty Medical ... Prior Authorization department. Reporting to the Pharmacy Operations Manager, you...following policy and procedure. + Provide on-call after hours nurse availability for urgent PA requests. + Provide internal… more
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