- Dexian - DISYS (Wyoming, DE)
- …expertise in Supply Planning & Analysis*SAP and JDA/Blue Yonder expertise* Prior managerial experience Interview process - Will hold two interviews ... efficient manner.Monitor and adjust master production plans to optimize resource utilization and meet forecasted demand, while also proactively evaluating and… more
- Conviva (Tallahassee, FL)
- …or customer service telephone experience desired + Experience with Utilization Review and/or Prior Authorization , preferably within a managed care ... Administration Coordinator - Phone Intake contributes to administration of utilization management. The UM Administration Coordinator performs varied activities and… more
- Humana (Columbus, OH)
- …experience with medical terminology and/or ICD-10 codes + Experience with Utilization Review and/or Prior Authorization , preferably within a managed care ... first** The UM Administration Coordinator 2 contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities… more
- CVS Health (Salt Lake City, UT)
- …Case management and discharge planning experience preferred + Discharge planning experience + Utilization review , prior authorization , concurrent ... and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. + Telephonic… more
- CVS Health (Richmond, VA)
- …Qualifications: - 2+ years of managed care experience.- Discharge planning experience preferred.- Utilization review , prior authorization , concurrent ... and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.- Monitor clinical… more
- Independent Health (Buffalo, NY)
- …Provide High Quality, Professional Utilization Management Services: (Medical necessity review for prior authorization , pre-certification, concurrent, as ... perks, benefits and commitment to diversity and inclusion. **Overview** The Utilization Review Nurse (URN) performs clinical review to determine the… more
- Humana (Columbus, OH)
- …(proficient to advanced) **Preferred Qualifications** + Experience with Utilization Review and/or Prior Authorization , preferably within a managed ... are the beginning, middle and end of processes for utilization management. This role partners with leadership, Medical Directors,...the nursing team + Builds and pends authorizations for review + Responsible for inbound and outbound calls to… more
- Centene Corporation (Jefferson City, MO)
- …interactions, and facilitates operations within utilization management. + Manages prior authorization , concurrent review , and retrospective clinical ... benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Manages Prior Authorization , Concurrent Review , and/or Retrospective … more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …The Role BHPS provides 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,...a high pace and changing environment. * Proficient in Utilization Review process including benefit interpretation, contract… more
- US Tech Solutions (LA)
- …nursing experience with a minimum of 1 year in utilization management/ prior authorization review experience. **Experience** : Utilization ... a hospital setting in a specialty area of the nursing field providing utilization management prior authorization reviews. Build strong direct relationships… more
- Billings Clinic (Billings, MT)
- …starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! Utilization Review RN Billings Clinic ... - 44.18 Under the direction of department leadership, the Utilization Review / Management RN. This position is...hours Ensure order in chart coincides with the payer review , CMS 2 Midnight Rule, or payer authorization… more
- Kelsey-Seybold Clinic (Pearland, TX)
- … authorization prior to services being rendered for members. The Utilization Review Specialist (LVN) serves as a liaison in reviewing requests for ... **Responsibilities** The Utilization Review Specialist (LVN) is responsible for conducting medical reviews, benefit verification, and applying criteria to… 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, ... required on Federal holidays. DUTIES OF THE LICENSED PRACTICAL NURSE (LPN/LVN) - UTILIZATION REVIEW : + Initiate, perform and complete assigned duties in… more
- Fallon Health (Worcester, MA)
- …+ In collaboration with the VP of Clinical Integration and Medical Directors, review the outcomes of prior authorization activities to continuously ... LinkedIn. **Brief Summary of Purpose:** Manages the daily operations of the Prior Authorization Unit; responsible for developing and implementing processes that… more
- University of Miami (Miami, FL)
- …initial, concurrent and retrospective chart reviews for clinical utilization and authorization . The Utilization Review Case Manager coordinates with the ... Operations have an exciting opportunity for a Full Time Utilization Review Case Manager to work at...advice. CORE FUNCTIONS: + Adhere and perform timely prospective review for services requiring prior authorization… 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:** + ... with Medcompass? + Do you have experience with Prior Authorization ? + Do you have experience with Utilization Review ? + Do you have an Active Registered… more
- The 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 ... records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and… more
- St. Luke's University Health Network (Allentown, PA)
- …serve, regardless of a patient's ability to pay for health care. The Network Prior Authorization and Referral Specialist is responsible for the coordination of ... information + Provides insurance company with clinical information necessary to secure prior - authorization or referral + Works in alignment with Central… more
- Fallon Health (Worcester, MA)
- …+ 3 years' experience, preferably in a managed healthcare environment, with prior authorization and utilization management processes and procedures ... us on Facebook, Twitter and LinkedIn. 3 days in the office ** Prior Authorization experience required** **Brief summary of purpose:** Performs all functions… more
- Kepro (Los Angeles, CA)
- …crucial role in optimizing the clinical review process by meticulously preparing prior authorization cases. You will be instrumental in ensuring that all ... vital partner for health solutions in the public sector. Acentra is looking for a Utilization Management Review Assistant to join our growing team. As a … more
