- Fallon Health (Worcester, MA)
- …us on Facebook, Twitter and LinkedIn. 3 days in the office ** Prior Authorization experience required** **Brief summary of purpose:** Performs all functions ... associated with completing tasks related to inpatient and prior authorization denial letters and special approval letters. This position serves as the subject… more
- University of Miami (Miami, FL)
- …compliance with medical advice. CORE FUNCTIONS: + Adhere and perform timely prospective review for services requiring prior authorization as well as ... has an exciting opportunity for a full time Utilization Review Case Manager to work to work remote...concurrent and retrospective chart reviews for clinical utilization and authorization . The Utilization Review Case Manager coordinates… more
- Kepro (AR)
- …limited degree of supervision. Responsibilities include, but are not limited to + Review first-level Prior Authorization (PA) requests related to ... timely decision-making and adjudication of dental claims, referrals, and pre-authorizations. Prior authorization and post payment reviews leverage patient care… more
- The Cigna Group (Bloomfield, CT)
- …in Utilization Management. Handles moderately complex medical review , utilization review , credentialing/re-credentialing, quality assurance/improvement, ... for the following: + Laboratory molecular and genetic testing clinical case review activities. + Evaluate telephone, fax, or web requests for authorization… 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 ... join our growing team. Job Summary: Our Nurse Clinical Reviewer will use clinical expertise for the review...NCQA, URAC and other regulatory standards. Position is full-time remote as long as you have an active unrestricted… more
- Kepro (Harrisburg, PA)
- …post-acute or rehabilitation environment required + Minimum of one year UR and/or Prior Authorization or related experience + Must be proficient in computer ... vital partner for health solutions in the public sector. Acentra seeks a Clinical Reviewer to join our growing team. Job Summary: Utilizes clinical expertise for the… more
- US Tech Solutions (Columbia, SC)
- …2-4 PREFERRED/NICE TO HAVE skill sets/qualities: I would love to have someone with prior insurance/utilization review experience, but I know that is not very ... equipment to be prepared. + The position is fully remote after that. + Please list out the top...The nurse would work remotely from their home reviewing authorization requests from providers for home health visits or… more
- Centene Corporation (New York, NY)
- …interdepartmental teams, to assess medical necessity of care of member + Escalates prior authorization requests to Medical Directors as appropriate to determine ... members + Provides feedback on opportunities to improve the authorization review process for members + Performs...plus holidays, and a flexible approach to work with remote , hybrid, field or office work schedules. Actual pay… more
- University of Michigan (Ann Arbor, MI)
- …+ Ability to meet and exceed departmental quality, production, and prior authorization standards. + Ability to review and resolve denials pertaining to ... Prior Authorization Specialist Apply Now **Job...and employees. + Ability to effectively work in a remote environment and connect via multiple communication channels (phone,… more
- CVS Health (Austin, TX)
- …plan/employer-agreed criteria within the designated service level agreements. - Evaluate and review all prior authorization requests and render coverage ... Specialty and Non-Specialty Pharmacy programs administered within the Commercial Prior Authorization and Case Review ...employee discount at all CVS stores. This is a remote role open to qualified candidates within the United… more
- Fairview Health Services (St. Paul, MN)
- …requirements are met per payor guidelines. They will provide support and process prior authorization appeals and denials, when necessary, in conjunction with ... departments if medical necessity fails. + Follow up with insurance payors on prior authorization denials. Process authorization denial appeals, when… more
- Centene Corporation (Tallahassee, FL)
- …- Saturday 9AM-6PM EST **Position Purpose:** Acts as a resource and supports the prior authorization request process to ensure that all authorization ... in accordance with policies and guidelines + Supports the authorization review process by researching and documenting... requests for services in accordance with the insurance prior authorization list and routes to the… more
- Insight Global (Charlottesville, VA)
- …and Requirements Requirements: * High school Diploma or equivalent * 2 years of prior authorization experience * Epic experience Reliable computer and high speed ... Job Description *This is a remote job opportunity however you must sit in...speed internet. * Insight Global is seeking a Pre- Authorization specialist for a large hospital system in Virginia.… more
- Molina Healthcare (Riverside, CA)
- …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
- 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
- Molina Healthcare (New York, NY)
- …who are eligible for Medicaid .** **We are looking for a RN Care Review Clinician with Prior Authorization experience. Candidates with Utilization Management ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
- Kepro (PA)
- …the efficiency of our review process. Your role involves meticulously preparing prior authorization cases for clinical review , streamlining operations to ... in facilitating our mission to provide timely and accurate review services. *Position is remote , but candidates...Prior experience in Quality Improvement (QI) or Utilization Review would be nice to have. Why us? We… 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 ... with a RN license and managed care UM experience-required. Prior Inpatient review experience and transplants highly...+ Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. +… more
- Tufts Medicine (Lawrence, MA)
- …under supervision. An entry level role that typically requires little to no prior knowledge or experience, work is routine or follows standard procedures, work is ... to the ordering department and Patient Access leadership for immediate review and resolution. 8. Collaborates with Financial Coordination and Pre-Registration… more
- Molina Healthcare (Florence, KY)
- **JOB DESCRIPTION** **Opportunity for a US licensed RN to do prior authorization reviews with Molina Healthcare. Applicants call across the contiguous US states ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more