- Medical Mutual of Ohio (OH)
- …perform pre-employment substance abuse and nicotine testing._ **Title:** _Prior Authorization Nurse Reviewer_ **Location:** _Ohio_ **Requisition ID:** _2400418_ ... Board. Bachelor's degree preferred. *3 years' experience as a Registered Nurse with a combination of clinical and utilization/case management experience, preferably… more
- Actalent (Dallas, TX)
- Job Title: Prior Authorization NurseJob Description The Prior Authorization Nurse is responsible for analyzing all prior authorization ... to promote quality and cost-effectiveness of medical care. Responsibilities + Analyze prior authorization requests to determine medical necessity of services and… more
- Molina Healthcare (Temecula, CA)
- **_JOB TITLE: CARE REVIEW CLINICIAN, PRIOR AUTHORIZATION (REGISTERED NURSE , OR LVN)_** **For this position we are seeking a Nurse with previous ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …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,...parties/departments. * Collaborates with healthcare partners to ensure timely review of services and care. * Provides referrals to… more
- US Tech Solutions (May, OK)
- …other clinical colleagues, healthcare professionals and members. + * Follow all prior authorization procedures to guarantee an accurate process on each ... data entry, data management, and reporting. **Experience:** + * Review criteria-based prior authorizations following policy and... prior authorization . + * Train and mentor… more
- US Tech Solutions (LA)
- **Position Summary:** As a Prior Authorization Nurse , you work outside the walls of a hospital setting in a specialty area of the nursing field providing ... indicated by staffing and business needs. **Duties:** + **Registered Nurse with current license in LA state of employment....with a minimum of 1 year in utilization management/ prior authorization review experience. **Experience**… more
- Select Medical (West Orange, NJ)
- **Overview** **Kessler Institute for Rehabilitation** West Orange, NJ ** Prior Authorization Specialist/Payor Relations Specialist ( RN , LPN )** **This is an** ... to receive insurance coverage for the care and services they need, as a Prior Authorization Specialist.** **Responsibilities** As a ** Prior Authorization … more
- Sanford Health (MN)
- …relating to the implementation, ongoing evaluation, and improvements to UM and/or prior authorization processes with applicable. Completes activities relating to ... determination of medical necessity, authorization , continued stay review including diagnosis and...and internal policies that effect resource utilization and potentially, prior authorization . Assists the department in monitoring… more
- Molina Healthcare (Las Vegas, NV)
- …benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina ... **_For this position we are seeking a (RN) Registered Nurse with previous experience in Hospital Acute Care, Concurrent...+ Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. +… 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,...process. + The Contractor performing as the License Practical Nurse (LPN) Utilization Reviewer (UR) shall make… more
- Martin's Point Health Care (Portland, ME)
- …when appropriate -Provide for continuity of care Job Description Key Outcomes/Results: + Review prior authorization requests ( prior authorization ... Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of...for inpatient/ outpatient authorizations. This position receives and reviews prior authorization requests for specific inpatient and… more
- CVS Health (Springfield, IL)
- …with other key business areas. + May develop/assist in development and/ review new training content + May collaborate/deliver interdepartmental training sessions + ... the needs of the department + 3+ years inpatient clinical experience as a Registered Nurse + 3+ years of Managed Care experience + 1+ years of Utilization Management… 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 ... knowledge of Milliman/MCG. + MUST HAVE 6 months of Prior Authorization . **Education:** + Active and unrestricted...Review ? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech Solutions… more
- Baptist Memorial (Memphis, TN)
- …strategy. Specifically the managed care techniques the Coordinator uses focuses on prior authorization for services using evidence based criteria. Areas of ... Summary The Authorization Coordinator is responsible for facilitating information documentation...incorrect payer with patient access + Communicate with Utilization Review Nurse + Works assigned queues in… more
- State of Nevada (NV)
- …equipment or supplies are medically necessary and in compliance with Medicaid criteria prior to approving or denying requests. Review records from the fiscal ... validate and ensure adequacy of services and resident care. Review health care providers and fiscal agents to ensure...including appropriateness for out of state placements. The HCC Nurse also is the dedicated clinical reviewer … 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
- Intermountain Health (Murray, UT)
- …member. + Applies evidence-based guidelines (eg InterQual) and medical policies with prior authorization and concurrent reviews and follows the applicable ... Marketplace Qualified Health Plans and commercial health plans. Utilization review behavior health professional proactively manage inpatient and outpatient… more
- US Tech Solutions (GA)
- …from distractions. You will provide processing and communication of specialty medication prior authorization (PA) requests reviewed by the Specialty Medical ... Prior Authorization department. Reporting to the Pharmacy Operations Manager, you...computer system data entry, data management, and reporting. + Review criteria-based prior authorizations following policy and… more
- Washington County (Stillwater, MN)
- Registered Nurse , Correctional Health - $3,000 hiring Incentive - Part Time/ Full Time - Evenings Print ... (https://www.governmentjobs.com/careers/washingtonmn/jobs/newprint/4638104) Apply Registered Nurse , Correctional Health - $3,000 hiring Incentive - Part Time/ Full… more
- MD Anderson Cancer Center (Houston, TX)
- …Practice Registered Nurse from the Texas State Board of Nursing prior to 1/1/2003. Graduate education and related Texas Board of Nursing authorization ... team in provision of care as warranted. Monitor and review findings of laboratory, clinical, radiographic, and procedural data...least one year of experience as Advanced Practice Registered Nurse . Prior experience working with Breast Cancer… more