- Ami Network (Pasadena, CA)
- …+ coordinator), and play a crucial role in providing operational leadership to the UM/ Prior Authorization and Inpatient Teams (50 FTEs in total). You'll be ... time. Requirements: * Healthplan Experience + Medicare Advantage * 3-5 years Management Experience * RN in CA * Daily audits of UM until they are in full compliance… more
- Christus Health (Corpus Christi, TX)
- …Patient Access Representative Nursing Assistant / Patient Care Technician Radiology Technician Registered Nurse Licensed Vocational Nurse Magnetic Resonance ... of your separation date Must obtain unit commander written authorization and approval to participate in DoD SkillBridge Program... and approval to participate in DoD SkillBridge Program prior to start of internship Must meet minimum qualifications… more
- Fallon Health (Worcester, MA)
- **Overview** **This is 3 months temporary contract position for a Prior Authorization RN .** **About us:** Fallon Health is a company that cares. We ... Nurse in a clinical setting required. * 2 years' experience as a Utilization Management/ Prior Authorization nurse in a managed care payer preferred. * One… more
- University of Miami (Miami, FL)
- …CORE FUNCTIONS: + Adhere and perform timely prospective review for services requiring prior authorization as well as timely concurrent review for continuation of ... initial, concurrent and retrospective chart reviews for clinical utilization and authorization . The Utilization Review Case Manager coordinates with the healthcare… more
- Humana (Dover, DE)
- …part of our caring community and help us put health first** Humana is seeking a Prior Authorization RN to join the Wisconsin Medicaid Market (iCare) team. ... This position reviews the clinical appropriateness of prior authorization (PA) requests and ensures that...make an impact** **Required Qualifications** + Licensed as a Registered Nurse in the State of Wisconsin,… more
- CVS Health (Baton Rouge, LA)
- …heart, each and every day. **Position Summary** The Utilization Management Manager of Prior Authorization oversees a team of clinical professionals to ensure the ... Lead, coach, and develop a multidisciplinary team responsible for utilization review, prior authorization , and case management functions. + Monitor team… more
- Fallon Health (Worcester, MA)
- …and inpatient, utilization management operations, including but not limited to prior authorization , concurrent review and discharge planning. + Ensures ... activities. + Recommends and implements innovative process improvements for the prior authorization and utilization management processes + Develops and… more
- UCLA Health (Los Angeles, CA)
- …This position is responsible for reviewing and evaluating clinical documentation related to prior authorization requests for medical services. The UM Review ... efficient utilization of resources. Key Responsibilities: + Conducts clinical reviews of prior authorization requests to evaluate medical necessity and benefit… more
- Humana (Oklahoma City, OK)
- **Become a part of our caring community and help us put health first** The Pre- Authorization Nurse 2 reviews prior authorization requests for appropriate ... and approves services or forward requests to the appropriate stakeholder. The Pre- Authorization Nurse 2 work assignments are varied and frequently require… 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 ... utilization management prior authorization reviews. Build strong direct relationships...as indicated by staffing and business needs. **Duties:** + ** Registered Nurse with current license in LA… more
- US Tech Solutions (Wichita, KS)
- …and implementation of QM Work Plan Activities **Experience:** + 3+ years of experience as an RN + Registered Nurse in state of residence + Must have ... + MUST HAVE 6 months of Prior Authorization . **Education:** + Active and unrestricted RN ...with Utilization Review? + Do you have an Active Registered Nurse License? **About US Tech Solutions:**… more
- Great River Health (West Burlington, IA)
- …with care team members to efficiently manage tasks such as referrals, prior authorization , phone calls, results notification, and medication refills. + ... & First Aid - American Heart Association within 60 Days Required + Registered Nurse Iowa Board of Nursing (IBON) (United States of America) Upon Hire Required… more
- North Shore Community Health (Salem, MA)
- Registered Nurse Salem, MA (http://maps.google.com/maps?q=47+Congress+Street+Salem+MA+USA+01970) Description Primary Purpose of Position: North Shore Community ... community healthcare delivery. We have an opening for a Registered Nurse . Under the general direction of...when needed within the scope of nursing practice, including prior authorization forms . Provides health education… more
- Humana (Richmond, VA)
- …your skills to make an impact** **Required Qualifications** + Active unrestricted Compact Registered Nurse , (eNLC) license ( RN ) with no disciplinary action ... you reside, with the ability to obtain multiple state registered nurse license + At least three...**Preferred Qualifications** + Bachelor's degree + Previous experience in prior authorization , claims, provider disputes and/or utilization… more
- Sevita (Lee's Summit, MO)
- …motivate us all every day. Join us today, and experience a career well lived. ** Registered Nurse - Part-Time** **$36/hr + $3,000 Sign-On Bonus | Hybrid Work ... and the unique impact Missouri nurses provide."_** As a Registered Nurse in Missouri, you deserve a...Do** + Conduct intake assessments and submit documentation for prior authorization based on pay sources +… more
- Actalent (Baton Rouge, LA)
- Job Title: Prior Authorization NurseJob Description The Prior Authorization Nurse plays a critical role in analyzing prior authorization ... assess the medical necessity of member care. + Escalate prior authorization requests to Medical Directors as...years of related experience. + LPN - Licensed Practical Nurse - State Licensure required. + RN … more
- Trinity Health (Albany, NY)
- …ass needed **What you will need:** **Required:** + A current license to practice as a Registered Nurse ( RN ) in the State of New York + Associate's degree ... well as insurance companies to manage insurance verifications and prior authorizations + Continual review and authorization ...long term care facility or home care as a RN + Prior experience in case management… more
- Mayo Clinic (Rochester, MN)
- …Competitive retirement package to secure your future. **Responsibilities** The Pain Medicine Registered Nurse ( RN ) works with adult patients experiencing ... nurse in this dynamic practice. The registered nurse ( RN ) is accountable...entry-level associate degree registered nurses with a RN start date prior to April 1,… more
- Mayo Clinic (Rochester, MN)
- …to Mayo Clinic, regardless of experience, will receive an extensive orientation program. The registered nurse ( RN ) is accountable for the coordination of ... powered by innovation and driven by purpose. As a registered nurse here, you'll be part of...entry-level associate degree registered nurses with a RN start date prior to April 1,… more
- Mayo Clinic (Rochester, MN)
- …retirement package to secure your future. **Responsibilities** The Palliative Medicine Registered Nurse ( RN ) collaborates with the interdisciplinary ... nurse in this dynamic practice. The registered nurse ( RN ) is accountable...entry-level associate degree registered nurses with a RN start date prior to April 1,… more
