- aptihealth (Clifton Park, NY)
- …+ Flexible working hours and lots of freedom in your work habits Your Role The Registered Nurse Case Manager team at AptiHealth is pivotal to the success of our ... appropriate care team member + Assist prescribers with medication prior authorization , coordination with pharmacy, medication refill...program, Bachelor's degree preferred + Currently licensed as a Registered Nurse in New York + Current… more
- MD Anderson Cancer Center (Houston, TX)
- …population. **EXPERIENCE** Preferred: At least one year of experience as Advanced Practice Registered Nurse . Prior experience working with Breast Cancer ... or verifies orders written by physician. The Advanced Practice Registered Nurse may write for other therapeutic...Nurse from the Texas State Board of Nursing prior to 1/1/2003. Graduate education and related Texas Board… more
- Providence (Beaverton, OR)
- …+ Bachelor's Degree in Nursing or Health Education + Upon Hire: Current unencumbered Registered Nurse License in Oregon + Within six months of hire date: ... Current unencumbered Registered Nurse License in Washington State +...Outpatient Care) + Utilization Management Experience (EX. Concurrent Review, Prior Authorization , Medical Audits, Appeals or Delegation)… more
- Providence (OR)
- …Nursing or Health Education + Within six months of hire date: Current unencumbered Registered Nurse License in Washington State + Case Management Experience (EX. ... of Outpatient Care) + Utilization Management Experience (EX. Concurrent Review, Prior Authorization , Medical Audits, Appeals or Delegation) + Experience… more
- Molina Healthcare (OH)
- **_For this position we are seeking a ( RN ) Registered Nurse with previous experience in Hospital Acute Care, Concurrent Review/ Utilization Review / ... for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of… 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 ... as assigned. QualificationsLicenses and Certifications: Current license to practice as a Registered Professional Nurse or an Occupational Therapist in New York… more
- Molina Healthcare (Milwaukee, WI)
- …keep reading about this rewarding work opportunity! We are currently looking for a Registered Nurse licensed in Wisconsin to become our next IRIS Self-Directed ... revises plan of care as needed + Submits for Prior Authorization for personal care services +...unrestricted license in the state of Wisconsin as a Registered Nurse . Valid Driver's License **PREFERRED EDUCATION:**… more
- Children's Hospital Boston (Boston, MA)
- …related to financial or insurance matters. To qualify, you must have : : + Valid Registered Nurse ( RN ) license in Massachusetts. + Minimum of 5 years of ... Authorization Support + Assisting with prescription refills and overseeing the prior authorization process for medications and medical equipment, ensuring… more
- Molina Healthcare (West Louisville, KY)
- **CARE REVIEW CLINICIAN INPATIENT REVIEW REGISTERED NURSE : KENTUCKY REMOTE ** **_For this position we are seeking a Registered Nurse with previous ... financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. + Processes… more
- Molina Healthcare (Milwaukee, WI)
- **JOB DESCRIPTION** **_For this position we are seeking a ( RN ) Registered Nurse with previous experience in Hospital Acute Care, Concurrent Review/ ... financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. + Processes… more
- Carle (Urbana, IL)
- …Work Location: Working from Home + Weekend Requirements: no + Other Posting Information: Registered Professional Nurse ( RN ) License Illinois upon hire. + ... EDUCATIONAL REQUIREMENTS Bachelor's Degree in Nursing CERTIFICATION & LICENSURE REQUIREMENTS Registered Professional Nurse ( RN ) License Illinois upon… more
- University of Michigan (Ann Arbor, MI)
- RN CASE MANAGER: University Hospital (Care Management) Apply Now **Job Summary** The RN Case Manager assesses, develops, implements, coordinates and monitors a ... utilization of resources while promoting quality outcomes. **Organizational Relationships** The RN Case Manager reports directly to the Manager of Care Management.… more
- Select Medical (Peoria, AZ)
- …venture with Select Medical & Banner Health Phoenix, Arionza ** Prior Authorization Specialist / Payor Relations Specialist** ** Remote position - Must live ... and independent judgment, the Payor Relations Specialist manages the pre-certification and prior authorization of referrals scheduled for admission to the Acute… more
- Molina Healthcare (Spokane, WA)
- …**JOB QUALIFICATIONS** **Required Education** Any of the following: Completion of an accredited Registered Nurse ( RN ), Licensed Vocational Nurse (LVN) ... medical clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ), Licensed Vocational Nurse … more
- Centene Corporation (Sacramento, CA)
- …management and healthcare providers, as appropriate, for any discrepancies between prior authorization and concurrent review processes to ensure clinically ... competitive benefits including a fresh perspective on workplace flexibility. Fully Remote Position that requires California RN Licensure. **Position Purpose:**… more
- Highmark Health (Harrisburg, PA)
- **Company :** Endorsed **Job Description :** **JOB SUMMARY** ** Remote /Hybrid - In home visits in and around Gibsonia, Blawnox, Fox Chapel, Glenshaw, Allison Park, ... from third party payers and placement to appropriate level of care prior to hospitalization utilizing medical necessity criteria and third party guidelines. Obtains… more
- Sanford Health (Fargo, ND)
- …* Responsible for communications with insurance companies as well as obtaining prior authorization when required * Identification and delivery of non-coverage ... one year on-site work and may consider transition to remote work if demonstrating competency in productivity and quality...and standards of nursing practice as outlined in the Nurse Practice Act and Administrative Rules in state of… more
- PeaceHealth (Vancouver, WA)
- …Subject matter expert.Responsible for receiving, processing and documenting referral or prior authorization requests from the clinical areas. Provides customer ... **Description** PeaceHealth is seeking a **Referral/Pre-Auth Specialist Lead - Remote for a Full Time, 1.00 FTE, Day position.** The salary range for this job… more
- PeaceHealth (Vancouver, WA)
- …**Job Summary** Responsible for receiving, processing and documenting referral or prior authorization requests from the clinical areas. Provides customer ... service and support for the clinical areas and patients for referrals and prior authorizations. **Essential Functions** + Oversees the data entry and completion of… more
- Martin's Point Health Care (Portland, ME)
- …including experience in care management/ disease management, utilization management and prior authorization . + Experience developing and managing health plan ... + Bachelor's degree in a clinical field of study ( RN , Pharmacy, etc.); Master's degree in nursing or related...findings in internal and external settings. This is a remote position with occasional travel to Portland, Maine. We… more