- US Tech Solutions, Inc. (Columbia, SC)
- …. Performs medical reviews using established criteria sets and/or performs utilization management of professional, inpatient or outpatient, facility benefits ... skill sets/qualities: I would love to have someone with prior insurance/ utilization review experience but I know...The nurse would work remotely from their home reviewing authorization requests from providers for home health visits or… more
- MUSC (Charleston, SC)
- …Nurse required. Prior leadership experience preferred. One year of case management and/or utilization review work experience preferred. Case Management ... Manager I serves as a clinical expert related to discharge planning, resource utilization , and case management . Minimum Training and Education: Bachelor's degree… more
- Community Health Plan of Washington (Medford, OR)
- …organization. * Create an equitable work environment. About the Role The Level I Utilization Management Clinician performs utilization review for medical or ... a physical health or behavioral health setting. * Have previous experience in Utilization Management and Managed Care, preferred. Essential functions and Roles… more
- MUSC (Charleston, SC)
- …details. Prior leadership experience preferred. One year of case management and/or utilization review work experience preferred. Required Licensure, ... I serves as a clinical expert related to discharge planning, resource utilization , and case management .Entity Medical University Hospital Authority (MUHA)Worker… more
- SunCrest Home Health - Manchester PD (Manchester, TN)
- …therapist(s) assignments for timely patient evaluation by signing off after authorization and plotting start of care (SOC) visits. Coordinates determination of ... agency services as indicated by the physician. Receives report from field clinicians prior to scheduled days off on patient status and ongoing needs. Processes new… more
- MUSC (Charleston, SC)
- …details. Prior leadership experience preferred. One year of case management and/or utilization review work experience preferred. Required Licensure, ... Manager I serves as a clinical expert related to discharge planning, resource utilization , and case management . Minimum Training and Education: Bachelor of… more
- Ochsner Home Health of New Orleans (Metairie, LA)
- …therapist(s) assignments for timely patient evaluation by signing off after authorization and plotting start of care (SOC) visits. Coordinates determination of ... agency services as indicated by the physician. Receives report from field clinicians prior to scheduled days off on patient status and ongoing needs. Processes new… more
- Assured Home Health (Tualatin, OR)
- …therapist(s) assignments for timely patient evaluation by signing off after authorization and plotting start of care (SOC) visits.Coordinates determination of ... agency services as indicated by the physician.Receives report from field clinicians prior to scheduled days off on patient status and ongoing needs.Processes new… more
- Brookdale Home Health St. Louis (Creve Coeur, MO)
- …therapist(s) assignments for timely patient evaluation by signing off after authorization and plotting start of care (SOC) visits.Coordinates determination of ... agency services as indicated by the physician.Receives report from field clinicians prior to scheduled days off on patient status and ongoing needs.Processes new… more
- Mederi Caretenders (Inverness, FL)
- …therapist(s) assignments for timely patient evaluation by signing off after authorization and plotting start of care (SOC) visits. Coordinates determination of ... agency services as indicated by the physician. Receives report from field clinicians prior to scheduled days off on patient status and ongoing needs. Follows-up with… more
- CVS Health (Austin, TX)
- …to work in a fast paced environment Preferred Qualifications + Previous prior authorization experience Education Associates degree required BSN preferred Pay ... Range The typical pay range for this role is: $29.10 - $62.31 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a… more
- CVS Health (Austin, TX)
- …up to 8:00pm EST zone (twice per month) Preferred Qualifications + Prior Authorization or Utilization Management experience + Managed care experience + ... are Monday-Friday 9a-6p in time zone of residence. Position Summary Precertification: Utilization Management Nurse Consultant + Utilizes clinical experience and… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- … 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,...with or without notice. Primary Responsibilities * Perform prospective utilization reviews and first level determinations for members using… more
- Providence (Beaverton, OR)
- …we must 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 operations + Be responsible for… more
- CVS Health (Princeton, NJ)
- …assess provider satisfaction. Assessment shall include provider experiences with claims processing, prior authorization , utilization management , and ... (HCQM) by the American Board of Quality Assurance and Utilization Review Physicians Preferred QualificationsProject management experience preferred.Education… more
- Banner Health (AZ)
- …costs. POSITION SUMMARY This position provides oversight of the utilization review, prior authorization and case management staff and activities. This ... in state worked. Five years of clinical RN experience in prior authorization , utilization review, or case management , with one year of experience in a… more
- Dignity Health (Bakersfield, CA)
- …**Preferred Qualifications:** - Preferred 5-7 years of experience in combination of utilization management prior authorization or acute/sub-acute ... Summary:** The Utilization Review LVN uses clinical judgement in providing utilization management services. The focus is to provide high quality… more
- Sanford Health (SD)
- …team regarding trends, external regulations and internal policies that effect resource utilization and potentially, prior authorization . Assists the ... Conduct level of care medical necessity reviews within patient's medical records. Performs utilization management (UM) activities in accordance with UM plan to… more
- CVS Health (Lansing, MI)
- …Nurse in state of residence 3+ years of Nursing experiencePreferred Qualifications Prior authorization utilization experience preferred Outpatient Clinical ... 8a-5pm Est time.) No travel is required.Applicants from any state can apply. Prior Authorization UM Nurse Consultant Utilizes clinical experience and skills in… more
- Dignity Health (Bakersfield, CA)
- …of Microsoft Office applications; Excel, Word, Outlook. **Preferred Qualifications:** - Utilization management (UM)/ prior authorization experience ... position is remote** **within California** **.** The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide… more
