- Fallon Health (Worcester, MA)
- …years' experience, preferably in a managed healthcare environment, with prior authorization and utilization management processes and procedures + Ability ... Facebook, Twitter and LinkedIn. 3 days in the office ** Prior Authorization experience required** **Brief summary of purpose:** Performs all functions associated… more
- The Cigna Group (Bloomfield, CT)
- …criteria reviews for providers, members and patient client advocates within the Prior Authorization / Utilization Management department. Identify and ... Nurse Case Management Lead Analyst-Nurse Clinician - Accredo Job Description...preferred + 5+ years of experience is preferred in prior authorization or utilization review… more
- Humana (Indianapolis, IN)
- …+ Ensures the transfer and receipt of all outstanding prior authorization decisions, utilization management data, and clinical information such ... as prevention and wellness programs(s), care management and complex case management notes. +... Certification (CCM) + Interqual or Millman experience + Prior experience with Medicare & Medicaid recipients + Previous… 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
- University of Miami (Miami, FL)
- …. The University of Miami UHealth System, Department of Utilization Management , has an exciting opportunity for an ... CORE FUNCTIONS: + Adhere and perform timely prospective review for services requiring prior authorization as well as timely concurrent review for continuation of… more
- Centene Corporation (Tallahassee, FL)
- …ROTATIONAL WEEKENDS AND HOLIDAYS IN THE FUTURE.** **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
- Centene Corporation (Atlanta, GA)
- …and 4+ years of related experience. Knowledge of utilization management principles preferred. Prior authorization preferred. **License/Certification:** + ... on key initiatives and to facilitate on-going communication between utilization management team, members, and providers + Monitors prior authorization ,… more
- Molina Healthcare (Riverside, CA)
- …seeking a LVN (Licensed Vocational Nurse) with experience in Prior Authorizations, Utilization Review / Utilization Management and knowledge of Interqual ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
- AmeriHealth Caritas (Dublin, OH)
- ** Utilization Management Plan Oversight Manager** Location: Dublin, OH Primary Job Function: Medical Management ID**: 37872 Your career starts now. We are ... Chief Medical Officer for the Ohio Market, this position is representing Utilization Management (UM) in state interactions/audits, validation of regulatory… more
- HonorHealth (Scottsdale, AZ)
- …for authorization of services and coordinates the timely completion of the authorization process for Utilization Management Department. The PA Specialist ... communities across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Prior Authorization (PA) Specialist is responsible for the review of… 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
- Select Medical (Lakeway, TX)
- …A joint venture with Select Medical & Baylor Scott & White Health ** Prior Authorization Specialist -** **onsite only** **This position must work** **onsite** ... and independent judgment, the Payor Relations Specialist manages the pre-certification and prior authorization of referrals scheduled for admission to the Acute… more
- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Utilization Management Reviewer has a key role in ensuring CCA meets ... facilities under the provisions of CCA's benefits plan. The Utilization Management (UM) Reviewer is responsible for...+ Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical… more
- Guthrie (Binghamton, NY)
- …and providers and staff, is responsible for the coordinates Utilization Management (UM) processes and requirements for prior authorization /certification ... LPN - Utilization Management (Days) Full Time Position...care services. The Utilization Reviewer: * Secures authorization as appropriate * Documents payer authorization … more
- CVS Health (Providence, RI)
- …solutions to make health care more personal, convenient and affordable. **Position Summary** Utilization Management is a 24/7 operation and work schedule may ... include weekends, holidays and evening hours. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and… more
- Dignity Health (Bakersfield, CA)
- …medical management by direct decision making in the areas of: prior authorization , concurrent review of hospitalized patients, discharge planning ... UM activities. This will include but not be limited to standardization of prior authorization reviews, coordinating coverage for vacations, holidays and weekends… more
- Billings Clinic (Billings, MT)
- …leadership and Physician Advisor, per department process or procedure Insurance and Utilization Management Maintains working knowledge of CMS requirements and ... Wage DOE: $35.34 - 44.18 Under the direction of department leadership, the Utilization Review/ Management RN. This position is to conduct initial, concurrent,… more
- Elevance Health (Tallahassee, FL)
- ** Utilization Management Representative II** **Location:** Must live within 50 miles of a Florida PulsePoint. The ** Utilization Management Representative ... eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization , and post service requests. + Obtains intake… more
- Elevance Health (Palo Alto, CA)
- ** Utilization Management Representative I** **Location:** This position will work a hybrid model (remote and office) and participate in health plan sponsored ... time - holidays and weekends may be required The ** Utilization Management Representative I** is responsible for...I** is responsible for coordinating cases for precertification and prior authorization review. **How you will make… more
- Elevance Health (Topeka, KS)
- ** Utilization Management Rep I** **Location:** This position will work a hybrid model (remote and office). Candidates must reside in Olathe, KS, Topeka, KS, or ... Overland Park, KS. The ** Utilization Management Rep I** is responsible for...I** is responsible for coordinating cases for precertification and prior authorization review. **How you will make… more