- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- … Utilization Management services to its clients. The Utilization Management Nurse - Prior Authorization performs medical necessity reviews on ... prior authorization requests in accordance with national standards, contractual requirements,...with or without notice. Primary Responsibilities * Perform prospective utilization reviews and first level determinations for members using… more
- Sanford Health (MN)
- …team regarding trends, external regulations and internal policies that effect resource utilization and potentially, prior authorization . Assists the ... relating to the implementation, ongoing evaluation, and improvements to UM and/or prior authorization processes with applicable. Completes activities relating to… more
- CVS Health (Springfield, IL)
- …**Position Summary:** The Associate Manager is responsible for oversight of Utilization Management/Case Management staff. This position is responsible for the ... + 3+ years inpatient clinical experience as a Registered Nurse + 3+ years of Managed Care experience +...years of Managed Care experience + 1+ years of Utilization Management experience + 1+ year Leadership experience (formal… more
- Actalent (Dallas, TX)
- Job Title: Prior Authorization NurseJob Description The Prior Authorization Nurse is responsible for analyzing all prior authorization ... to promote quality and cost-effectiveness of medical care. Responsibilities + Analyze prior authorization requests to determine medical necessity of services and… more
- Molina Healthcare (Temecula, CA)
- **_JOB TITLE: CARE REVIEW CLINICIAN, PRIOR AUTHORIZATION (REGISTERED NURSE , OR LVN)_** **For this position we are seeking a Nurse with previous ... experience in Prior Auth Utilization Management and knowledge of Interqual or MCG guidelines....and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility… more
- The Arora Group (Bethesda, MD)
- Licensed Practical Nurse (LPN) - Utilization Review Nurse Currently recruiting a Licensed Practical Nurse (LPN/LVN) - Utilization Review in Bethesda, ... Services will be required on Federal holidays. DUTIES OF THE LICENSED PRACTICAL NURSE (LPN/LVN) - UTILIZATION REVIEW: + Initiate, perform and complete assigned… more
- Medical Mutual of Ohio (OH)
- …perform pre-employment substance abuse and nicotine testing._ **Title:** _Prior Authorization Nurse Reviewer_ **Location:** _Ohio_ **Requisition ID:** _2400418_ ... Nursing Board. Bachelor's degree preferred. *3 years' experience as a Registered Nurse with a combination of clinical and utilization /case management experience,… more
- Martin's Point Health Care (Portland, ME)
- …for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental policies as well as ... "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member...for inpatient/ outpatient authorizations. This position receives and reviews prior authorization requests for specific inpatient and… 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
- CVS Health (Santa Fe, NM)
- …6 hours a day working with providers to secure additional information for prior authorization review. This candidate will utilize clinical skills to coordinate, ... utilization management) experience within an inpatient/outpatient setting, concurrent review or prior authorization . + 1+ years Managed Care (MCO) preferred.… 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
- CVS Health (Raleigh, NC)
- …late shift up to 8:00pm EST zone (twice per month) **Preferred Qualifications** + Prior Authorization or Utilization Management experience + Managed care ... to promote quality effectiveness of Healthcare Services and benefit utilization + Consults and lends expertise to other internal...Qualifications** + 3+ years of experience as a Registered Nurse + Must have active current and unrestricted RN… more
- Select Medical (West Orange, NJ)
- **Overview** **Kessler Institute for Rehabilitation** West Orange, NJ ** Prior Authorization Specialist/Payor Relations Specialist ( RN , LPN )** **This is an** ... to receive insurance coverage for the care and services they need, as a Prior Authorization Specialist.** **Responsibilities** As a ** Prior Authorization … more
- ERP International (Nellis AFB, NV)
- **Overview** ERP International is seeking **Registered Nurse (RN) Utilization Managers** for full-time positions in support of theMike O'Callaghan Military ... Weekends, No Holidays! **Job Specific Position Duties:** * Provides Utilization Management activities and functions by using MTF specific...* Ensures Line of Duty paperwork is on file prior to authorization for all reserve and… 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 ... utilization review, care coordination experience + California Registered Nurse (RN) - CA Board of Registered Nursing -REQUIRED **Preferred Qualifications**… more
- Commonwealth Care Alliance (Boston, MA)
- …**What You'll Be Doing:** + Oversees clinical decision review for services requiring prior authorization in a variety of clinical areas, + including but ... is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting… more
- Ascension Health (Nashville, TN)
- …and inpatientutilization management programs. + Oversee implementation and maintenance of prior authorization codes for all clients. **Requirements** Licensure / ... **Details** + **Department:** Utilization Management + **Schedule:** Monday - Friday. 40...Certification / Registration: + Registered Nurse credentialed from the Tennessee Board… more
- VNS Health (Manhattan, NY)
- …appropriateness of admissions, treatment, level of care and lengths of stay. Performs prior authorization and concurrent reviews to ensure extended treatment is ... subject matter experts, physicians, member representatives, and discharge planners in utilization tracking, care coordination, and monitoring to ensure care is… more
- Actalent (Doral, FL)
- Utilization Management Nurse Job Description The role...+ Utilization management + Concurrent review + Utilization review + Prior authorization + ... of the Utilization Management (UM) Nurse is to promote quality, cost-effective outcomes for a...+ Minimum 2 years of experience in prospective clinical review/ prior authorizations and retrospective review + Clinical experience in… more
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