- Daiichi Sankyo, Inc. (Seattle, WA)
- …landscapes with expertise in formulary decisions, reimbursement policy, utilization management criteria, prior authorization processes and appeal ... in-person and telephone assistance to oncology HCPs to foster understanding and utilization of DSI and/or third party reimbursement support including but not limited… more
- CVS Health (Raleigh, NC)
- …to 8:00pm EST zone (twice per month) **Preferred Qualifications** + Prior Authorization or Utilization Management experience + Managed care experience + ... of experience with Microsoft Office applications (Outlook, Teams, Excel) + Utilization Management is a 24/7 operation and work schedules may include weekends,… more
- Fallon Health (Worcester, MA)
- …years' experience, preferably in a managed healthcare environment, with prior authorization and utilization management processes and procedures + Ability ... **Overview** **The Prior Authorization Letter Writer position works M - F 8 am to 5 pm/ 8:30 am to 5 pm and will require at least 6 months of training 5… more
- 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
- CVS Health (Springfield, IL)
- …affordable. **Position Summary:** The Associate Manager is responsible for oversight of Utilization Management /Case Management staff. This position is ... Nurse + 3+ years of Managed Care experience + 1+ years of Utilization Management experience + 1+ year Leadership experience (formal or informal roles) + Travel… more
- Humana (Baton Rouge, LA)
- …an acute or outpatient behavioral health setting + Experience with Utilization Management or Prior Authorization + Experience with behavioral change, ... part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and… more
- TEKsystems (Tempe, AZ)
- …insurance Additional Skills & Qualifications: -2+ years of dental insurance experience - utilization management - prior authorization , referrals -front ... Utilization Management Representative Remote Pay Rate: $20/hr Expected Start Date: 11/18 Schedule: M-F 8am-5pm Description: A person in this role will be… more
- Sanford Health (MN)
- …team regarding trends, external regulations and internal policies that effect resource utilization and potentially, prior authorization . Assists the ... Conduct level of care medical necessity reviews within patient's medical records. Performs utilization management (UM) activities in accordance with UM plan to… more
- Corewell Health (Grand Rapids, MI)
- …Functions + Provides operational management over the Behavioral Health Outpatient Prior Authorization program, Utilization Management , Outpatient ... audits of staff performance related to concurrent review, discharge planning and prior authorization . + Assists Director with budget preparation and monitoring,… more
- US Tech Solutions (LA)
- …walls of a hospital setting in a specialty area of the nursing field providing utilization management prior authorization reviews. Build strong direct ... Minimum 3 years nursing experience with a minimum of 1 year in utilization management / prior authorization review experience. **Experience** : … more
- Actalent (Dallas, TX)
- Job Title: Prior Authorization NurseJob Description The Prior Authorization Nurse is responsible for analyzing all prior authorization requests ... to promote quality and cost-effectiveness of medical care. Responsibilities + Analyze prior authorization requests to determine medical necessity of services and… more
- Spectrum Billing Solutions (Skokie, IL)
- …is managed in the most efficient and streamlined manner. We are seeking to add an ABA Prior Authorization / UR Specialist to our growing team. The ABA Prior ... billing software). + Understanding of mental and behavioral health treatment services. Utilization Review Specialist | Utilization Management Specialist |… more
- AmeriHealth Caritas (Dublin, OH)
- ** Utilization Management Plan Oversight Manager (Ohio Resident)** Location: Dublin, OH Primary Job Function: Medical Management ID**: 37872 **Job Brief** ... Chief Medical Officer for the Ohio Market, this position is representing Utilization Management (UM) in state interactions/audits, validation of regulatory… more
- Molina Healthcare (Temecula, CA)
- …OR LVN)_** **For this position we are seeking a Nurse with previous experience in Prior Auth Utilization Management and knowledge of Interqual or MCG ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
- Fairview Health Services (St. Paul, MN)
- …3-5 years of acute care hospital nursing experience. + Excellent computer and database management skills. + Prior Utilization Review experience is highly ... **Overview** M Health Fairview has an immediate opening for a Utilization Management Specialist RN. This position provides comprehensive assessment, planning,… more
- Sharp HealthCare (San Diego, CA)
- …competency and individual development planning process.Maintain current knowledge of case management , utilization management , and discharge planning, as ... referrals for care and services are directed to appropriate network providers, and obtains prior authorization for in network and out of network services as… more
- ERP International (Nellis AFB, NV)
- …No Call, No Weekends, No Holidays! **Job Specific Position Duties:** * Provides Utilization Management activities and functions by using MTF specific Quality ... disciplines to include discharge planning and referrals for case management . * Utilization management duties...* Ensures Line of Duty paperwork is on file prior to authorization for all reserve and… more
- WellSpan Health (York, PA)
- …requirement satisfaction, and staff engagement. + Provide oversight of utilization management , denials and Prior Authorization activities to ensure ... Full Time General Summary Supervises and oversees the operations of the utilization management department. Works with hospital, regional, medical group,… more
- Commonwealth Care Alliance (Boston, MA)
- …and facilities under the provisions of CCA's benefits plan.The Manager, Utilization Management is responsible for overseeing and managing the ... daily operation of the Utilization Management Review Nurse and Specialist staff...Doing:** + Oversees clinical decision review for services requiring prior authorization in a variety of clinical… 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
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