- Molina Healthcare (Columbus, OH)
- …benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina ... its members. + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional… more
- Molina Healthcare (Columbus, OH)
- …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 ** **_1 opening for 12 hour NIGHT SHIFT: 7:30PM (in the evening) - 08:30AM (in the morning) PACIFIC HOURS NON EXEMPT, 3 days… more
- Centene Corporation (Tallahassee, FL)
- …services to ensure level of care and services are medically appropriate + Performs prior authorization reviews related to mental health and substance abuse to ... or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required Pay Range: $26.50 -… more
- Molina Healthcare (Troy, MI)
- …financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. + Processes ... **JOB DESCRIPTION** _For this position we are seeking a (RN) Registered Nurse who lives in MICHIGAN and must be licensed for the state of MICHIGAN. We cannot accept… more
- Centene Corporation (Tucson, AZ)
- …(BH) and/or autism spectrum disorder needs and clinical standards + Performs prior authorization reviews related to BH to determine medical appropriateness ... + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required + Board Certified Behavior… more
- Molina Healthcare (Chicago, IL)
- …financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. + Processes ... REGISTERED NURSE must be licensed for the state of Illinois and must be willing to work CENTRAL daytime business hours 9AM to 6PM.** **JOB DESCRIPTION** **Job… more
- Eastern Connecticut Health Network (Manchester, CT)
- …to the Manager of Behavioral Health Crisis and takes direction from the Clinical Nurse Manager of the department where they are floated. Provides direct and indirect ... certification within 6 months of hire into the role. EXPERIENCE: + Prior experience working in the Behavioral Health field, preferably to specific prospective… more
- The Cigna Group (Bloomfield, CT)
- Nurse Case Management Lead Analyst- Nurse Clinician - Accredo Job Description Summary The Nurse Clinician - RN is responsible for reviewing escalated ... reviews for providers, members and patient client advocates within the Prior Authorization /Utilization Management department. Identify and track trends for… more
- US Tech Solutions (Wichita, KS)
- …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
- Option Care Health (Washington, DC)
- …hiring, developing, and retaining a diverse workforce. **Job Description Summary:** An Infusion Nurse is a licensed clinician who coordinates and provides direct ... an accredited school of nursing and at least 1 year of experience as a registered nurse or recent graduate with prior experience as an IV Certified LVN/LPN with… 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 ... 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 (RI)
- …experience required. + Must have experience with Medcompass + Must have prior authorization utilization experience. + Managed Care/Medicare experience preferred. ... MANAGEMENT EXP, pref. knowledge of Milliman/MCG. + MUST HAVE 6 months of Prior Authorization . **Education:** + RN with current unrestricted state licensure… more
- Hackensack Meridian Health (Hackensack, NJ)
- …/Radiation Oncology services in the HMH Health care system. This pertains to Prior Authorization for Oncology services, as well as various specialized services ... needs to be rescheduled due to missing Referral or Authorization number. Works with departmental supervisor and/or clinician...in order to avoid technical denials for lack of prior authorization . Understand if payer rules governing… more
- Henry Ford Health System (West Bloomfield, MI)
- …Specialist is responsible for handling drug claim adjudication issues, prescription prior authorization , and pharmacy benefit inquiries from members/patients, ... expert in the resolution of pharmacy benefit coverage issues and coordinating prior authorization and exception processes. PRINCIPLE DUTIES AND RESPONSIBILITIES:… more
- University of Utah Health (Salt Lake City, UT)
- …for evaluation. Collaborates with Transplant Financial Coordinators to assure appropriate authorization obtained for patients prior to evaluation visit. + ... our mission. EO/AA_ Under the direction of the RN Nurse Coordinator and Transplant Management, the Transplant Program Specialist...and assure completion and appropriate follow up by transplant clinician of all orders in EMR and OSH +… more
- Option Care Health (Omaha, NE)
- …patient contact to ascertain supply needs as designated by the clinician and establish relationship with client. Communicates information to appropriate personnel ... patient orders on system. Coordinates and executes shipping schedule. Communicates with Nurse and Pharmacist to ensure availability of patient supplies and confirms… more
- Northern Light Health (South Portland, ME)
- …assigns clinical team member to patient based on geographical region and clinician availability, utilizing clinical knowledge to support clinical team needs + ... obtaining authorized DME/supplies for Hospice patients as requested, verifies de- authorization of Hospice medical supplies/equipment and pharmaceuticals completed upon… more