- Centene Corporation (New York, NY)
- …have an active New York State nursing license.** **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service ... medical necessity of care of member + Escalates prior authorization requests to Medical ...management processes preferred. **License/Certification:** + LPN - Licensed Practical Nurse - State Licensure required + RN - Registered… 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
- UCLA Health (Los Angeles, CA)
- …clinical documentation related to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards, ... Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role in ensuring the delivery...of resources. Key Responsibilities: + Conducts clinical reviews of prior authorization requests to evaluate medical… more
- CVS Health (Madison, WI)
- …with heart, each and every day. **Position Summary:** The **Utilization Management Clinical Nurse Consultant - Prior Authorization ** utilizes clinical skills ... ), or PST ( _Pacific Standard Time_ ). + Previous experience with prior authorization . + Previous experience with utilization management. + Previous experience… 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
- 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... uses a multidisciplinary approach to review service requests ( prior -authorizations), focusing on selected complex medical and… 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. ... we are. + **POSITION SUMMARY:** Reviews, analyzes, and interprets complex medical information, applying specific knowledge of coding requirements and conventions to… more
- Mayo Clinic (Rochester, MN)
- …and written). Experience working in a team environment. Computer skills required, prior experience with electronic medical record systems preferred. Ability to ... long, successful career with Mayo Clinic. **Benefits Highlights** + Medical : Multiple plan options. + Dental: Delta Dental or...of practice experience, hired into a scheduled FTE Registered Nurse position on the Rochester campus of Mayo Clinic… more
- Mayo Clinic (Rochester, MN)
- …classes. Nurses continue their education by attending neuroscience specialty days and medical specialty nursing conferences. The registered nurse (RN) is ... and written). Experience working in a team environment. Computer skills required, prior experience with electronic medical record systems preferred. Ability to… more
- Mayo Clinic (Rochester, MN)
- …and written). Experience working in a team environment. Computer skills required, prior experience with electronic medical record systems preferred. Ability to ... long, successful career with Mayo Clinic. **Benefits Highlights** + Medical : Multiple plan options. + Dental: Delta Dental or...Model is the nursing care delivery system. The registered nurse (RN) is accountable for the coordination of nursing… more
- Mayo Clinic (Rochester, MN)
- …and written). Experience working in a team environment. Computer skills required, prior experience with electronic medical record systems preferred. Ability to ... can build a long, successful career with Mayo Clinic. **Benefits Highlights** + Medical : Multiple plan options. + Dental: Delta Dental or reimbursement account for… more
- US Tech Solutions (GA)
- …medication prior authorization (PA) requests reviewed by the Specialty Medical Prior Authorization department. Reporting to the Pharmacy Operations ... staff and customer service, admissions and pharmacy operations departments to communicate prior authorization status. You will also oversee fax processing and… more
- Louisiana Department of State Civil Service (St. Gabriel, LA)
- PRACTICAL NURSE -LICENSED 1, 2, OR 3 Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4776460) Apply PRACTICAL NURSE -LICENSED 1, 2, OR 3 ... has a Special Entrance Rate at each level Practical Nurse -Licensed 1 has an SER of $19.48 per hour....employee may be required to serve a trial detail prior to being permanently promoted. + TEMPORARY JOB APPOINTMENT:… more
- State of Colorado (Denver, CO)
- …with outside providers for the committed and detained youth. Point of contact for prior authorization for specialized medical care. Responsible to track all ... Lead Mid-Level Provider / Nurse Practitioner - Gilliam Youth Services Center -... prior authorization requests to ensure accuracy and follow-through. Participates or… more
- Louisiana Department of State Civil Service (St. Gabriel, LA)
- REGISTERED NURSE 1, 2, OR 3 Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4776430) Apply REGISTERED NURSE 1, 2, OR 3 Salary Depends on ... has a Special Entrance Rate at each level Registered Nurse 1 has an SER of $29.84 per hour....employee may be required to serve a trial detail prior to being permanently promoted. + TEMPORARY JOB APPOINTMENT:… more
- Louisiana Department of State Civil Service (Kinder, LA)
- REGISTERED NURSE 1, 2, OR 3 Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4780542) Apply REGISTERED NURSE 1, 2, OR 3 Salary Depends on ... employee may be required to serve a trial detail prior to being permanently promoted + TEMPORARY JOB APPOINTMENT:...has a Special Entrance Rate at each level Registered Nurse 1 has an SER of $29.84 per hour.… more
- Louisiana Department of State Civil Service (Angie, LA)
- REGISTERED NURSE 1, 2 or 3 (WAE) Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4777670) Apply REGISTERED NURSE 1, 2 or 3 (WAE) Salary ... degree, certificate, special license, or DD-214 must be verified by official documentation prior to hire. + Any qualifying experience that is based on college… more
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