- 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
- Centene Corporation (New York, NY)
- …**Must have a New York State nursing license.** **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
- 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
- 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
- Guthrie (Cortland, NY)
- …coordination of Utilization Management (UM) processes and requirements of prior authorization /certification for reimbursement of patient care services. The ... payers, Care Coordination and other hospital departments as appropriate to obtain prior authorization required to meet contractual reimbursement requirements and… more
- Humana (Richmond, VA)
- …Qualifications** + Bachelor's degree + Previous experience in prior authorization , claims, provider disputes and/or utilization management in healthcare, ... our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- CVS Health (Austin, TX)
- …and work schedules will include holidays and evening hours **Preferred Qualifications** + Prior Authorization or Utilization Management experience + Managed ... Friday, 10am to 7pm EST with occasional holiday rotation. Utilization Management is a 24/7 operation and work schedules...Qualifications** + 3+ years of experience as a Registered Nurse + Must have active current and unrestricted RN… 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 (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
- US Tech Solutions (Columbia, SC)
- …but could be extended. + A typical day would like in this role: Process prior authorization requests for Medicare Advantage line of business. + Team: Fast paced, ... Interactive team works with multiple applications to process authorization and appeals requests using Medicare criteria. **Responsibilities:** + Reviews and… more
- Actalent (San Antonio, TX)
- …nurses to assist each other and complete cases. Qualifications: + 3+ years of utilization management, concurrent review, prior authorization , utilization ... review, case management, and discharge planning is must + Active RN Compact License is Must If you are Interested , Kindly give a call : ### Job Type & Location This is a Contract position based out of San Antonio, TX. Pay and Benefits The pay range for this… more
- Humana (Oklahoma City, OK)
- **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 (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 ... services or forward requests to the appropriate stakeholder. The Pre- Authorization Nurse 2 work assignments are varied...to Tier III care management as needed. * Perform prior authorization reviews according to established HUMANA… more
- Centene Corporation (Madison, WI)
- …between utilization management team, members, and providers + Monitors prior authorization , concurrent review, and/or retrospective clinical review nurses ... anywhere in the Central time zone. The role supervises Prior Authorization Nurses and is primarily Monday...ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources… 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
- AmeriHealth Caritas (Washington, DC)
- …2 years of experience applying evidence-based criteria (eg InterQual) to complete prior authorization and concurrent reviews for inpatient and/or outpatient ... **$5,000.00 SIGN ON BONUS** **Role Overview** Our Utilization Management Reviewers evaluate medical necessity for inpatient...3 years of diverse clinical experience as a Registered Nurse in an Intensive Care Unit (ICU), Emergency Department… more
- Centene Corporation (Springfield, IL)
- …services to ensure level of care and services are medically appropriate + Performs prior authorization reviews related to mental health and substance abuse to ... in various mental health settings especially inpatient behavioral health units, utilization management / review, and youth or pediatric services.** Additional… more
- Elevance Health (Costa Mesa, CA)
- … 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
- Elevance Health (Miami, FL)
- …eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization , and post service requests. + Obtains intake ... ** Utilization Management Representative II** **Virtual:** This role enables...to screen basic and complex requests for precertification and/or prior authorization . + Verifies benefits and/or eligibility… more
- Elevance Health (Durham, NC)
- …Management Representative I** will be responsible for coordinating cases for precertification and prior authorization review. **How you will make an impact:** + ... **Title: Utilization Management Representative I** **Location:** **Winston Salem,...provides authorization for inpatient admission, outpatient precertification, prior authorization , and post service requests. +… more
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