• Utilization Management Coordinator…

    Sanford Health (ND)
    …28.00 **Department Details** Opportunity to work remotely. **Job Summary** Monitors the utilization of resources, risk management and quality of care for patients in ... Collection of clinical information necessary to initiate commercial payor authorization . Obtain and maintain appropriate documentation concerning services in… more
    Sanford Health (11/21/24)
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  • Nurse Clinician: Prior

    Molina Healthcare (San Bernardino, CA)
    _JOB TITLE: CARE REVIEW CLINICIAN, PRIOR AUTHORIZATION (REGISTERED NURSE , OR LVN)_ **JOB DESCRIPTION** **Job Summary** Molina Healthcare Services (HCS) works ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
    Molina Healthcare (10/17/24)
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  • Prior Authorization Nurse

    Health First (Rockledge, FL)
    …skills. **Job:** **Medical Management* **Organization:** **HF Administrative Plan Inc* **Title:** * Prior Authorization Nurse Specialist HFHP - Clinical ... associated with a sustainable, measurable, accurate, reliable and timely execution of the Prior Authorization Process. Success in this position will be based on… more
    Health First (11/21/24)
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  • Clinical Review Nurse - Prior

    Centene Corporation (Sacramento, CA)
    …100% remote. Candidate must have CA RN Licensure.** **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service and ... interdepartmental teams, to assess medical necessity of care of member + Escalates prior authorization requests to Medical Directors as appropriate to determine… more
    Centene Corporation (11/26/24)
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  • Licensed Practical Nurse (LPN)…

    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
    The Arora Group (11/22/24)
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  • Utilization Review Nurse

    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
    US Tech Solutions (10/18/24)
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  • RN Registered Nurse Director…

    Ascension Health (Tulsa, OK)
    utilization management programs. + Oversee implementation and maintenance of prior authorization codes for all clients. **Requirements** Licensure / ... **Details** + **Department:** Utilization Management + **Schedule:** FT, Monday-Friday, 8am-5pm +...Certification / Registration: + Registered Nurse credentialed from the Oklahoma Board… more
    Ascension Health (11/21/24)
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  • Utilization Review Nurse

    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
    US Tech Solutions (10/18/24)
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  • Utilization Management Nurse

    CVS Health (Richmond, VA)
    …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
    CVS Health (11/26/24)
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  • Pre- Authorization Registered Nurse

    Humana (Enid, OK)
    …Spouse looking for an internship that supports the goal to put health first? The Prior Authorization , Registered Nurse , RN, Intern will review prior ... of professional onsite, field, or remote based opportunities. The Prior Authorization , Registered Nurse , RN,...Previous Medicare/Medicaid experience a plus. + Previous experience in prior authorization , utilization management +… more
    Humana (11/23/24)
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  • Pre- Authorization Registered Nurse

    Humana (Frankfort, KY)
    **Become a part of our caring community and help us put health first** The Pre- Authorization Nurse 2 reviews prior authorization requests for appropriate ... and approves services or forward requests to the appropriate stakeholder. The Pre- Authorization Nurse 2 work assignments are varied and frequently require… more
    Humana (11/20/24)
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  • LVN or RN Clinician, Prior

    Molina Healthcare (ID)
    …benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina ... + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. +...Any of the following: Completion of an accredited Registered Nurse (RN), Licensed Vocational Nurse (LVN) or… more
    Molina Healthcare (11/09/24)
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  • Manager, Utilization Management (Concurrent…

    Centene Corporation (Madison, WI)
    …issues related to member care, provider interactions, and facilitates operations within utilization management. + Manages prior authorization , concurrent ... a fresh perspective on workplace flexibility. **Position Purpose:** Manages Prior Authorization , Concurrent Review, and/or Retrospective Review Clinical… more
    Centene Corporation (11/23/24)
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  • RN- Utilization Management

    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
    ERP International (11/02/24)
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  • SRS-Inpatient Case Manager II - Utilization

    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
    Sharp HealthCare (10/30/24)
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  • Market Director of Utilization Management

    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
    Ascension Health (10/25/24)
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  • Utilization Management RN (mostly remote)

    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
    VNS Health (11/05/24)
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  • Utilization Review Manager-Selikoff Centers…

    Mount Sinai Health System (New York, NY)
    **Job Description** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program operations within a ... and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and coordinate… more
    Mount Sinai Health System (10/31/24)
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  • Utilization Management LPN

    Adecco US, Inc. (Minneapolis, MN)
    …Current LVN/LPN license in State of Residence * 2+ years of care management, utilization review ( prior authorization ) or discharge planning experience **Why ... Adecco Healthcare & Life Sciences is hiring for a ** Utilization Management** **LPN** to work **remotely** ! This is...**Location:** Remote / work from home **Responsibilities of the Utilization Management LPN:** * In collaboration with the Manager… more
    Adecco US, Inc. (11/13/24)
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  • Utilization Management Representative II

    Elevance Health (Tampa, FL)
    …eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization , and post service requests. + Obtains intake ... ** Utilization Management Representative II** **Location:** Must live within...to screen basic and complex requests for precertification and/or prior authorization . + Verifies benefits and/or eligibility… more
    Elevance Health (11/05/24)
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