- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA ... Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization ...+ Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical… more
- 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
- 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 ... Stanford Health Care **What you will do** + Inpatient & SNF Utilization Management & Care Coordination: + Support proactive hospital discharge planning, transfers,… 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 ... the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity...of care from initial assess point. Follows cases for authorization for in patient stay. + Staff review short… 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...Twitter and LinkedIn. **Brief summary of purpose:** The PA Nurse uses a multidisciplinary approach to review service requests… more
- CVS Health (Baton Rouge, LA)
- …heart, each and every day. **Position Summary** The Utilization Management Nurse Consultant (UMNC) for Prior Authorization conducts high-acuity, timely, ... supporting regulatory compliance and organizational goals. Key Responsibilities: * Perform prior authorization clinical reviews of acute admissions using… 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
- 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 ... Description At UCLA Health, the Utilization Management (UM) Review Nurse plays...of resources. Key Responsibilities: + Conducts clinical reviews of prior authorization requests to evaluate medical necessity… more
- Actalent (Minnetonka, MN)
- … for Post Acute care, you will be responsible for reviewing and documenting prior authorization and concurrent stay requests. You will also manage member case ... Utilization Management Nurse Job Description As...long-term acute care hospitals. Responsibilities + Review and document prior authorization and concurrent stay requests. +… 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:** + MUST ... + Do you have experience with Prior Authorization ? + Do you have experience with Utilization... Review? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech Solutions… more
- CDPHP (Latham, NY)
- …responsible for the clinical review and documentation for services requiring prior authorization . This includes approval determinations and appropriate ... of acute care experience is required as a Registered Nurse . + Minimum of two (2) years Utilization... Nurse . + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of coding/claims… more
- CVS Health (Austin, TX)
- …with Microsoft Office applications (Outlook, Teams, Excel) **Preferred Qualifications** + Prior Authorization or Utilization Management experience in ... 8-5 PM in your time zone and is for a** **Medicare Precertification Nurse .** _Utilization Management is a 24/7 operation and work schedules will include holidays… more
- US Tech Solutions (May, OK)
- …hospital experience . Registered Nurse in state of residence . Must have prior authorization utilization experience . Able to work in multiple IT ... and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review. . MUST HAVE 1 YEAR OF...knowledge of Milliman/MCG. . MUST HAVE 6 months of Prior Authorization . Education: . Active and unrestricted… more
- Centene Corporation (New York, NY)
- …Provider. + Provides first level RN review for all outpatient and ancillary prior authorization requests for medical appropriateness and medical necessity using ... license; and a NYS Driver's License or Identification card.** **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for all… more
- CVS Health (Phoenix, AZ)
- …1 year of Utilization Management experience in concurrent review or prior authorization . + Strong decision-making skills and clinical judgment in independent ... for members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our...+ Experience in a high-volume clinical call center or prior remote work environment. **Education** + Associate's degree in… 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 onsite. ... position: *Manages the design, development, implementation, and monitoring of utilization review functions. Oversees daily operations, which include supervising… more
- PeaceHealth (Bellingham, WA)
- **Description** PeaceHealth is seeking a RN Admissions/ Utilization Behavioral Health - Care Management for a Full Time, 1.00 FTE, Day position. The salary range for ... assistance may be available.** **Job Summary** Responsible for promoting effective utilization and monitoring of healthcare resources. This position will assume an… more
- SSM Health (OK)
- …license as they will provide cross coverage for MO / WI/ OK admissions. Prior experience in Utilization Review is required. **Job Summary:** Evaluates the ... to support services provided by hospital. Ensures hospital receives authorization from payor. **Job Responsibilities and Requirements:** PRIMARY RESPONSIBILITIES +… 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
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