- CVS Health (Lansing, MI)
- …schedule 8a-5pm Est time.) No travel is required.Applicants from any state can apply. Prior Authorization UM Nurse Consultant Utilizes clinical ... in state of residence 3+ years of Nursing experiencePreferred Qualifications Prior authorization utilization experience preferred Outpatient Clinical experience… more
- CVS Health (Carson City, NV)
- …required 3 weeks training required 100% participation during 8:30am-5pm EST Monday-Friday As a UM Nurse Consultant you will work in a clinical telephone queue ... working with providers to secure additional information for prior authorization reviews. -This candidate will utilize clinical skills to coordinate, document and… more
- Molina Healthcare (New York, NY)
- …**We are looking for a RN Care Review Clinician with Prior Authorization experience. Candidates with Utilization Management ( UM ) and MLTC/LTC experience are ... and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility...teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional travel to other… more
- Sharp HealthCare (San Diego, CA)
- …Day **FTE** 1 **Shift Start Time** **Shift End Time** California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing & Psychiatric Technicians; Other ... + Other : Graduate of an accredited Licensed Vocational Nurse (LVN) program + 3 Years experience in the...or home coordinating with the SNF admission liaison for authorization of level of care as appropriate. Assists with… 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,...preferred. Essential Qualifications * Current licensed LPN or Registered Nurse (RN) with state licensure. Must retain active and… more
- Providence (Beaverton, OR)
- …empower them._** **Providence Health Plan is calling a Manager Utilization Management RN, Prior Authorization who will:** + Be responsible for Management and ... supervision of the PHP Utilization Management ( UM ) or Care Management (CM) clinical programs, outcomes and...training in supervision, management, or leadership + Oregon Registered Nurse License + 3+ years of experience directly managing… 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 ... MANAGED CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review. . MUST HAVE...knowledge of Milliman/MCG. . MUST HAVE 6 months of Prior Authorization . Education: . Active and unrestricted… more
- US Tech Solutions (RI)
- …experience required. + Must have experience with Medcompass + Must have prior authorization utilization experience. + Managed Care/Medicare experience preferred. ... MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review. + MUST HAVE...knowledge of Milliman/MCG. + MUST HAVE 6 months of Prior Authorization . **Education:** + RN with current… more
- CVS Health (Phoenix, AZ)
- …clinical information from providers. Required Qualifications + 1+ year: Oncology and Transplant UM , concurrent review or prior authorization + 3+ years: ... training required 100% participation during 8:30am-5pm Monday-Friday EST. + A Registered Nurse that must hold an unrestricted license in their state of residence,… more
- Sanford Health (Sioux Falls, SD)
- …activities relating to the implementation, ongoing evaluation, and improvements to UM and/or prior authorization processes with applicable. ... regulations and internal policies that effect resource utilization and potentially, prior authorization . Assists the department in monitoring the utilization… more
- Fallon Health (Worcester, MA)
- …of purpose** : Under the direction of the Manager of Prior Authorization , communicates with contracted and non-contracted facilities/agencies/providers to ... collect pertinent prior authorization request data and disseminates information...in QNXT as a result of determinations made by Authorization Coordinators, Nurse Reviewers and/or Nurse… more
- YesCare Corp (Bartow, FL)
- … hospital experience with five (5) years corrections experience + Minimum of two (2) years prior experience with UM preferred + Minimum of one (1) year prior ... **Experience & Requirements** + Licensed Registered Professional Nurse currently registered to practice in state of...+ Serves as resource to sites and providers for authorization numbers + Forwards daily inpatient case management abstracts… more
- Billings Clinic (Billings, MT)
- …CM, and department leadership *Conducts UR until all tasks are completed; indicates UM Complete in authorization and/or certification *Communicates with payer UR ... Requirements All new employees must complete several pre-employment requirements prior to starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more!… more
- CDS Life Transitions (Webster, NY)
- …and Experience: + Bachelor's degree in Nursing + State licensure as a Registered Nurse (RN) + Minimum 2 years of prior experience in Utilization Management ... results of these reviews to all involved parties. The UM reviewer will facilitate the timely access to necessary,...within established policy time frames, along with reasons for authorization or denial, supported by objective and unbiased criteria… more
- Centene Corporation (Salem, OR)
- …a fresh perspective on workplace flexibility. **Position Purpose:** Supervises Prior Authorization , Concurrent Review, and/or Retrospective Review Clinical ... communication between utilization management team, members, and providers + Monitors prior authorization , concurrent review, and/or retrospective clinical review… more
- Centene Corporation (NJ)
- …a fresh perspective on workplace flexibility. **Position Purpose:** Manages Prior Authorization , Concurrent Review, and/or Retrospective Review Clinical ... interactions, and facilitates operations within utilization management. + Manages prior authorization , concurrent review, and retrospective clinical review… more
- Sanford Health (Sioux Falls, SD)
- …regulations and internal policies that effect resource utilization and potentially, prior authorization . Assists the department in monitoring the utilization ... and federal regulatory requirements. Maintain working knowledge of payer standards for UM functions for authorization requirements. May assist with additional… more
- Molina Healthcare (Lexington, KY)
- …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 who must be licensed for the state they...+ Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. +… more
- Elevance Health (Atlanta, GA)
- …Management Representative I** will be responsible for coordinating cases for precertification and prior authorization review. **How you will make an impact:** + ... eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization , and post service requests. + Refers cases… more
- Ellis Medicine (Schenectady, NY)
- …The Discharge Planner's primary function is to work with the Social Worker, Nurse Case Manager, or Utilization Management Nurse to facilitate patient discharge ... in utilization management activities under the direction of a registered nurse and/or social worker. Responsibilities include maintaining case files, updating… more