- Genmab (Berkeley Heights, NJ)
- …not limited to Medicare, Medicaid and commercial insurance carriers, Prior Authorization submissions/appealsUnderstanding of the healthcare industry, including ... of insurance coverage including review of benefit verifications, research of prior authorizations and support through the appeals processEvaluate and refer patients… more
- Aveanna Healthcare (Cedar Rapids, IA)
- …O complete and document the client start of care Submit required documentation for prior authorization of client services as needed based on client's pay sources ... contribution to team shared on-call rotation. Position Overview The Admissions Registered Nurse (RN) works next to the Clinical Manager and/or Executive Director to… more
- NORTH RANGE BEHAVIORAL HEALTH (Greeley, CO)
- …ensure payment of services; align services with payor authorizations and/or request authorization prior to provision of service. Assume responsibility to follow ... - Greeley, CO Salary Range $68900.00 - $103240.00 Salary Description Registered Nurse Crisis Stabilization Services Acute Treatment Unit Shift: Friday and Saturday… more
- Commonwealth Care Alliance (Boston, MA)
- …Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical areas, including but ... **Required Knowledge, Skills & Abilities (must have):** + Experience with prior authorization and retrospective reviews + Proficiency reviewing clinical/medical… more
- Luke Staffing (Yigo, GU)
- ** NURSE - REFERRAL MANAGEMENT** **SITE OF SERVICE:** +...+ Ensures Line of Duty paperwork is on file prior to authorization . + Verify eligibility of ... Base, Guam + Full Time **POSITION QUALIFICATION/REQUIREMENTS:** + **Education:** Vocational Nurse Program OR Baccalaureate of Science in Nursing Program from an… more
- PharmaCord (Jeffersonville, IN)
- …Identifies and communicates patient's plan benefit coverage including the need for prior authorization , appeal, tier exception, and/or formulary exclusions Uses ... from the PharmaCord pharmacy Proactively communicates needs for reverification of prior authorization or re-enrollment for patient assistance program Reports… more
- PharmaCord (Lexington, KY)
- …and communicates patient's plan benefit coverage including the need for prior authorization , appeal, tier exception, and/or formulary exclusions. Serves ... support resources for patients. Proactively communicates needs for reverification of prior authorization or re-enrollment. Identifies and reports adverse events,… more
- Universities of Wisconsin (Oshkosh, WI)
- …MS Social Work: MSW Graduate Lecturer Positions: Minimum Education Requirements MSN Nurse Educator emphasis, Social Work, Kinesiology: PhD or other terminal degree ... DNP Family Nurse Practitioner, Nurse Anesthesia, and/or Psychiatric Mental...complete all required fields and attach all required documents prior to submitting the online application. Note: Once you… more
- Lucile Packard Children's Hospital (Palo Alto, CA)
- …specific authorization and supervision of a licensed physician or nurse . Administers medication following approved procedures and only after verification of ... and collects medication information. * Prepares patient examination rooms prior to the visit to ensure that proper equipment...* Performs the following procedures as directed by Registered Nurse (RN)/ Nurse Practitioner (NP)/ Physician (MD) and… more
- PharmaCord (Jeffersonville, IN)
- …necessary. Identify and communicate patients' plan benefit coverage, including any prior authorization , appeal, tier exception, or formulary exclusion ... the PharmaCord pharmacy. Proactively communicate the need for re-verification of prior authorization or re-enrollment for patient assistance programs. Report… more
- Commonwealth Care Alliance (Boston, MA)
- …Director of Utilization Management - Oversees clinical decision review for services requiring prior authorization in a variety of clinical areas, including but ... (must have): - Expertise in managing utilization review processes including prior authorization , concurrent and retrospective reviews - Demonstrated ability… more
- Stony Brook University (Stony Brook, NY)
- …with nurse case manager/social worker team regarding payer delays, authorization and denial notification. + Serve as a liaison between hospital departments ... team, who assist with transitional office operations. Individual works closely with Nurse Case Managers and Social Workers regarding payer delays, authorization … more
- Stony Brook University (Stony Brook, NY)
- …with the transferring hospital, Patient Access and physicians and payers for authorization prior to transfer from other hospitals. + Consistent documentation ... of care from initial assess point. Follows cases for authorization for in patient stay. + Staff review short...required. **Qualifications** **Required** : A Bachelor's degree or a nurse working on their degree with an RN license… more
- GIBSON AREA HOSPITAL (Gibson City, IL)
- …chemistry testing, immunology testing, and microbiology testing as ordered. 16. Obtain prior authorization (s) for procedures and testing. 17. Follows Infection ... and staff. The responsibility for direct oversight is that of the Physician, Nurse Practitioner, and Physician Assistant, for which the CMA/MA is working for. GIBSON… more
- Moses/Weitzman Health System (Bethel, CT)
- …by laws in a timely manner, included by not limited to intake, prior authorization request, progress notes, treatment plan documentation, and discharge. + ... the original pilot developments within the Weitzman Institute: the National Nurse Practitioner Residency and Fellowship Training Consortium (NNPRFTC), the National… more
- Cordis (Irvine, CA)
- …experience with cardiovascular procedures in clinical research in this same role or as a nurse or tech as radiology tech or Cath lab tech + Minimum 3 years' ... experience working directly with physicians and healthcare professionals + Prior experience with clinical trials (preferred) + Experience in coronary or peripheral… 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
- Fallon Health (Worcester, MA)
- …Nurse in a clinical setting required. + 2 years' experience as a Utilization Management/ Prior Authorization nurse in a managed care payer preferred. + One ... on Facebook, Twitter and LinkedIn. **Brief summary of purpose:** The PA Nurse uses a multidisciplinary approach to review service requests ( prior… 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 ... policy and procedure. + * Provide on-call after hours nurse availability for urgent PA requests. + * Provide... prior authorization . + * Train and mentor... prior authorization . + * Train and mentor representatives on the… more
- Centene Corporation (New York, NY)
- …**Must have a New York State nursing license.** **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service and ... interdepartmental teams, to assess medical necessity of care of member + Escalates prior authorization requests to Medical Directors as appropriate to determine… more
