- Molina Healthcare (New York, NY)
- …**We are looking for a RN Care Review Clinician with Prior Authorization experience. Candidates with Utilization Management ( UM ) and MLTC/LTC experience are ... and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility...teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional travel to other… more
- Molina Healthcare (Riverside, CA)
- …benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina ... this position we are seeking a LVN (Licensed Vocational Nurse ) with experience in Prior Authorizations, Utilization...+ Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. +… more
- Baystate Health (Springfield, MA)
- …issues, specifically related to outlier cases, long LOS cases or complicated prior authorization requests + Understand member insurance products and benefits, ... **Position** Licensed Practical Nurse **SCHEDULE:** + Full time + Monday -...benefits education, and HNE's medical policy requirements related to prior authorization requirements. + Interact with external… more
- LA Care Health Plan (Los Angeles, CA)
- …health, behavioral health, social services, and MLTSS. Responsible for UM authorization functions for services requiring prior auths. Provides direction to ... Managed Long Term Services and Supports Nurse Specialist RN II Job Category: Clinical Department:...adhere to regulatory mandates that apply to Utilization Management ( UM ) and Care Management (CM). Collaborate with Skilled Nursing… more
- US Tech Solutions (Chicago, IL)
- …an RN + Registered Nurse in state of residence + Must have prior authorization utilization experience + Experience with Medcompass **Skills:** + MUST HAVE ... MANAGEMENT EXP, pref. knowledge of Milliman/MCG. + MUST HAVE 6 months of Prior Authorization . **Education:** + Active and unrestricted RN licensure in state… more
- US Tech Solutions (May, OK)
- …experience . Registered Nurse in state of residence . Must have prior authorization utilization experience . Able to work in multiple IT platforms/systems ... MANAGED CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review. . MUST HAVE...knowledge of Milliman/MCG. . MUST HAVE 6 months of Prior Authorization . Education: . Active and unrestricted… more
- Kepro (ND)
- …of North Dakota or a compact state license. + 1+ years of Utilization experience Review ( UM ) and/or Prior Authorization or related experience. + 3+ years of ... in the public sector. Acentra is looking for a Nurse (RN) Clinical Reviewer to join our growing team....Reviewer to join our growing team. Job Summary: Our Nurse Clinical Reviewer will use clinical expertise for the… more
- US Tech Solutions (RI)
- …experience required. + Must have experience with Medcompass + Must have prior authorization utilization experience. + Managed Care/Medicare experience preferred. ... MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review. + MUST HAVE...knowledge of Milliman/MCG. + MUST HAVE 6 months of Prior Authorization . **Education:** + RN with current… more
- Fallon Health (Worcester, MA)
- …of purpose** : Under the direction of the Manager of Prior Authorization , communicates with contracted and non-contracted facilities/agencies/providers to ... collect pertinent prior authorization request data and disseminates information...in QNXT as a result of determinations made by Authorization Coordinators, Nurse Reviewers and/or Nurse… more
- Centene Corporation (Atlanta, GA)
- …experience. Knowledge of utilization management principles preferred. Prior authorization preferred. **License/Certification:** + RN - Registered Nurse - ... including a fresh perspective on workplace flexibility. Position Purpose: Supervises Prior Authorization , Concurrent Review, and/or Retrospective Review Clinical… more
- Billings Clinic (Billings, MT)
- …CM, and department leadership Conducts UR until all tasks are completed; indicates UM Complete in authorization and/or certification Communicates with payer UR ... Requirements All new employees must complete several pre-employment requirements prior to starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more!… more
- Elevance Health (Topeka, KS)
- …**Utilization Management Rep I** is responsible for coordinating cases for precertification and prior authorization review. **How you will make an impact:** + ... eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization , and post service requests. + Refers cases… 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 ... evidenced based medical criteria, and regulatory requirements to ensure appropriate authorization of services and execution of the plan's fiduciary responsibilities.… 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 ... evidenced based medical criteria, and regulatory requirements to ensure appropriate authorization of services and execution of the plan's fiduciary responsibilities.… more
- Molina Healthcare (IA)
- …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. +...teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional travel to other… more
- University of Michigan (Ann Arbor, MI)
- …are met + Communicates with third party payers to obtain necessary authorization for reimbursement of services. + Obtain anticipated LOS from provider and ... Night Shift Weekend Differential- $6.90 / hour + Charge Nurse Differential- $1.00 / hour The benefit package includes:...met or will have met all the required qualifications prior to the start date of employment. RESUME REQUIRED… more
- HonorHealth (Scottsdale, AZ)
- …the payers. Position develops and oversees the ICP Utilization Management and Prior Authorization department. Develops, leads and directs the implementation of ... compliance with IOCP minimum requirements where applicable. Manages the UM /PA team including quality improvement programs. Evaluates and fosters collaborative… more
- Molina Healthcare (Sacramento, CA)
- …financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. + Processes ... **EMERGENCY ROOM ADMISSIONS REVIEW NURSE ** **_PERMANENT SHIFT WILL BE :_** **_12 hour...teams to promote Molina Care Model. + Adheres to UM policies and procedures. + Occasional travel to other… more
- Molina Healthcare (Tampa, FL)
- …financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. + Processes ... **_For this position we are seeking a (RN) Registered Nurse with previous experience in Hospital Acute Care, Concurrent...teams to promote Molina Care Model. + Adheres to UM policies and procedures. + Occasional travel to other… more
- Molina Healthcare (Louisville, KY)
- …financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. + Processes ... are seeking a candidate with WA State LICSW, LMHC, LMFT, or Psychiatric Nurse RN licensure. Candidates should be proficient with Microsoft Office products, ie Excel,… more