- CVS Health (Oklahoma City, OK)
- …both verbal and written **Required Qualifications** + 3+ years of experience as a Registered Nurse + Must have active, current and unrestricted Oklahoma RN ... per business needs **Preferred Qualifications** + Utilization management, precertification, prior authorization experience strongly preferred + Managed Care… more
- Molina Healthcare (NV)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
- US Tech Solutions (Wichita, KS)
- …and implementation of QM Work Plan Activities **Experience:** + 3+ years of experience as an RN + Registered Nurse in state of residence + Must have ... + MUST HAVE 6 months of Prior Authorization . **Education:** + Active and unrestricted RN ...with Utilization Review? + Do you have an Active Registered Nurse License? **About US Tech Solutions:**… more
- Molina Healthcare (Kenosha, WI)
- **JOB DESCRIPTION** **_For this position we are seeking a ( RN ) Registered Nurse with previous experience in Hospital Acute Care, Concurrent Review/ ... financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. + Processes… more
- Molina Healthcare (TX)
- …financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. + Processes ... acute care/medical experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. Must… 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 ... acute care/medical experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing. Must… more
- Molina Healthcare (Madison, WI)
- …financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. + Processes ... care/medical experience. **Required License, Certification, Association** Active, unrestricted Wisconsin Registered Nursing ( RN ) license in good standing. Must… more
- Elevance Health (Tampa, FL)
- …managed care experience is strongly preferred. + Previous Medical Review and/or Prior Authorization /Pre-Certification experience is preferred. + Knowledge of the ... enrolled in Medicaid and/or Medicare programs in Florida. **Medical Management Clinician Associate** **Location:** The selected candidates must reside in the state… more
- Centene Corporation (Cheyenne, WY)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... ensure level of care and services are medically appropriate + Performs prior authorization reviews related to mental health and substance abuse to determine… more
- Centene Corporation (Tallahassee, FL)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... and/or autism spectrum disorder needs and clinical standards + Performs prior authorization reviews related to BH to determine medical appropriateness in… more
- US Tech Solutions (May, OK)
- …. Registered Nurse in state of residence . Must have prior authorization utilization experience . Able to work in multiple IT platforms/systems Skills: ... Medicare). . Independently coordinates the clinical resolution with internal/external clinician support as required. . Processes and evaluates complex.... MUST HAVE 6 months of Prior Authorization . Education: . Active and unrestricted RN … more
- Louisiana Department of State Civil Service (Lake Charles, LA)
- …Professional Nurses Practice Act. Level of Work: Entry. Supervision Received: Close from a Registered Nurse or Practical Nurse of a higher level. Supervision ... and draft discharge summaries for both ImHealthy and medication management patients; Prior authorization requests & denials for Lake Charles; Trains other… more
- Hackensack Meridian Health (Neptune, NJ)
- …/Radiation Oncology services in the HMH Health care system. This pertains to Prior Authorization for Oncology services, as well as various specialized services ... in order to avoid technical denials for lack of prior authorization . Understand if payer rules governing...to convey and communicate to clinical care givers (Physicians, Nurse Practitioners and RN case managers. +… more
- Option Care Health (Washington, DC)
- …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 one ... retaining a diverse workforce. **Job Description Summary:** An Infusion Nurse is a licensed clinician who coordinates...year professional nursing experience. + Required license in Registered Nursing as granted by the state(s) of practice.… more
- Banner Health (Loveland, CO)
- …BONUS!** - 1 Year Commitment Required Day to day: rooming patients, vitals, prior authorization requests, assisting providers and staff, suture removal, cast ... indicative of change in the patient's condition to the clinician . 2. Assists providers with exams and minor in-office...- Typical Direct Patient Care environment: (Nutrition Rep, Chaplain, RN ) Able to stand, walk, bend, squat, reach, and… more
- University of Utah Health (Salt Lake City, UT)
- …that are integral to our mission. EO/AA_ Under the direction of the RN Nurse Coordinator and Transplant Management, the Transplant Program Specialist proactively ... for evaluation. Collaborates with Transplant Financial Coordinators to assure appropriate authorization obtained for patients prior to evaluation visit. +… more
- US Tech Solutions (RI)
- …UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. + MUST HAVE 6 months of Prior Authorization . **Education:** + RN with current unrestricted state ... experience required. + Must have experience with Medcompass + Must have prior authorization utilization experience. + Managed Care/Medicare experience preferred.… more
- Actalent (Arlington, VA)
- …Case Manager + Inpatient case management and discharge planning experience + Prior authorization experience + Healthcare experience Additional Skills & ... program quality and cost-effectiveness of case management activities. The clinician must be self-motivated and able to learn in...continuity of services. Essential Skills + Case management + RN + Critical Care + Specialty RN … more
- Actalent (Arlington, VA)
- …Qualifications + BLS certification. + State License in VA. + Experience with prior authorization and healthcare processes. Work Environment The position requires ... improvements in program quality and cost-effectiveness of case management activities. The clinician must be self-motivated and able to learn in a fast-paced… more