- Other Executive (Highland Park, TX)
- …Leads Tenet Hospital case management operations to develop and implement centralized utilization review and authorization management services by market ... Teams market structure and operations management to effectively support utilization review and authorization confirmation...or obtain approval of a religious or medical exemption prior to your start date. If you receive an… more
- Delray Medical Center (Delray Beach, FL)
- …activities: a) accurate medical necessity screening and submission for Physician Advisor review , b) securing and documenting authorization for services from ... patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient's resources and...obtain an approval of a religious or medical exemption prior to your start date. If you receive an… more
- NY CREATES (Albany, NY)
- … Review trade payment breakdowns.Perform MWBE function to maximize utilization participation, submit utilizations plans to sponsor agencies to ensure compliance ... and external departments to ensure submitted documentation is complete for the review and approval of invoices.Provide aid to senior finance staff in support… more
- Insight Global (Irvine, CA)
- …of clinical experience working as an LVN/LPN * 2+ years of care management, utilization review ( prior authorization ) or discharge planning experience ... liaison between Health Plan delegated entities and Clinical Services Operational teams ( Utilization Management and Case Management) * Serves as a liaison between… more
- CVS Health (Richmond, VA)
- …2+ years of case management experience preferred.- Discharge planning experience preferred.- Utilization review , prior authorization , concurrent ... and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.- Monitor clinical… more
- Humana (Columbus, OH)
- …or customer service telephone experience desired + Experience with Utilization Review and/or Prior Authorization , preferably within a managed care ... first** The UM Administration Coordinator 2 contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …The 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,...a high pace and changing environment. * Proficient in Utilization Review process including benefit interpretation, contract… more
- Sanford Health (MN)
- …- $28.00 **Department Details** Opportunity to work remote **Job Summary** Monitors the utilization of resources, risk management and quality of care for patients in ... Collection of clinical information necessary to initiate commercial payor authorization . Obtain and maintain appropriate documentation concerning services in… more
- US Tech Solutions (LA)
- …nursing experience with a minimum of 1 year in utilization management/ prior authorization review experience. **Experience** : Utilization ... a hospital setting in a specialty area of the nursing field providing utilization management prior authorization reviews. Build strong direct relationships… more
- Billings Clinic (Billings, MT)
- …(https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! RN - Utilization Review (Full-time/Billings) CARE MANAGEMENT ... loan reimbursement Under the direction of department leadership, the Utilization Review / Management RN. This position is...hours *Ensure order in chart coincides with the payer review , CMS 2 Midnight Rule, or payer authorization… more
- Fallon Health (Worcester, MA)
- …+ In collaboration with the VP of Clinical Integration and Medical Directors, review the outcomes of prior authorization activities to continuously ... LinkedIn. **Brief Summary of Purpose:** Manages the daily operations of the Prior Authorization Unit; responsible for developing and implementing processes that… 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 ... for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental policies as well as… more
- University of Miami (Miami, FL)
- …initial, concurrent and retrospective chart reviews for clinical utilization and authorization . The Utilization Review Case Manager coordinates with the ... compliance with medical advice. CORE FUNCTIONS: + Adhere and perform timely prospective review for services requiring prior authorization as well as… more
- Martin's Point Health Care (Portland, ME)
- …cases. + Coordinates referrals to Care Management, as appropriate. + As needed, may also review prior authorization requests ( prior authorization , ... for reviewing claims disputes and retrospective requests for services requiring clinical review prior to payment. The Utilization Review Nurse will… 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, perform and complete assigned duties in… more
- Centene Corporation (Topeka, KS)
- …members based on prior experience and recommends improvements related to utilization review processes + Analyzes BH member data and identifies improvements ... review of member medical records to the utilization review BH team + Provides guidance...substance abuse + Performs and manages the most complex prior authorization reviews related to mental health… more
- St. Luke's University Health Network (Allentown, PA)
- …serve, regardless of a patient's ability to pay for health care. The Network Prior Authorization and Referral Specialist is responsible for the coordination of ... information + Provides insurance company with clinical information necessary to secure prior - authorization or referral + Works in alignment with Central… more
- US Tech Solutions (Chicago, IL)
- …as an RN + Registered Nurse in state of residence + Must have prior authorization utilization experience + Experience with Medcompass **Skills:** + ... with Medcompass? + Do you have experience with Prior Authorization ? + Do you have experience with Utilization Review ? + Do you have an Active Registered… more
- CVS Health (Atlanta, GA)
- …pharmacists, other clinical colleagues, healthcare professionals and members. - Follow all prior authorization procedures to guarantee an accurate process on ... computer system data entry, data management, and reporting. - Review criteria-based prior authorizations following policy and...each prior authorization . - Train and mentor representatives… more
- Adecco US, Inc. (Woonsocket, RI)
- …pharmacists, other clinical colleagues, healthcare professionals and members + Follow all prior authorization procedures to guarantee an accurate process on each ... by the Commercial PA team for Pharmacy benefits. + Review criteria-based prior authorizations following policy and... prior authorization + Train and mentor representatives… more
