- AltaMed Health Services Corporation (Montebello, CA)
- …Vocational Nurse . Minimum of 2 years of managed care experience in Utilization Management/ prior authorization required. A minimum requirement of a valid ... that drives us forward every day. Job Overview The LVN Utilization Management Nurse (UM Nurse ) will provide routine review of authorization requests from… more
- Sonder Health Plans, Inc. (Atlanta, GA)
- …that require additional clinical management support *Conducts initial review of prior authorization or pre-certification requests for determination of coverage ... for you to join us. Sonder Health Plans is looking for a full-time Utilization Management Nurse to make sure our health services are administered efficiently… more
- Mindful Care (Hoboken, NJ)
- We are seeking Board Certified Psychiatric Mental Health Nurse Practitioners (PMHNP) to expand access to behavioral health care in your area. If you're passionate ... while maintaining control over their schedule. We handle patient scheduling, prior authorizations, case management, billing, and other support functions. Our… more
- Curative HR LLC (Austin, TX)
- …expertise, established medical policies, and evidence-based guidelines. Conduct thorough prior authorization reviews, ensuring alignment with clinical criteria, ... team. This pivotal role will be responsible for overseeing and performing utilization reviews, prior authorizations, and making crucial medical necessity… more
- CenCal Health (Santa Barbara, CA)
- …Conduct accurate and timely prospective (pre-service) reviews for services requiring prior authorization . Perform timely concurrent reviews for inpatient care ... $84,877 - $123,072 Annually Job Summary The Health Plan Nurse Coordinator - Adult Utilization Management (HPNC...accurate and timely retrospective (post-service) reviews for services requiring prior authorization but not obtained by the… more
- KMA Human Resources Consulting (South Portland, ME)
- …clinical direction for patients when their physicians are unavailable. Participates in utilization review and prior authorization requests. Supports ... Chest Medicine Associates Physician Assistantor Nurse Practitioner South Portland, Maine Chest Medicine Associates...Chest Medicine Associates is seeking a Physician Assistant or Nurse Practitioner to be based in the South Portland… more
- Morgan Stephens (Long Beach, CA)
- …discharge planners, and providers to ensure smooth and timely placements. Manage prior authorization processes and confirm Medicaid eligibility. Collaborate with ... licensed in California Job Type: Full-Time Department: Care Management / Utilization Management Salary: $90,000 Position Summary: A leading managed care organization… more
- Carle Health (Olney, IL)
- …1 or more years experience - External Applicants Only Under the supervision of the Nurse Manager, the staff Registered Nurse (RN) is a professional caregiver who ... a designated time frame and provides care to these patients via the utilization of the nursing process, nursing trends, technology, financial and human resources… more
- Texas A&M University System (College Station, TX)
- Job Title Registered Nurse II - Prior Authorization & Referral Agency Texas A&M University Health Science Center Department University Health Services ... team-based health care delivery. What we want The Registered Nurse II- Prior Authorization and Referral,...experience in at least one of the following areas: Prior authorizations or utilization management , c… more
- Centene Corporation (New York, NY)
- …**8:30am-5pm, Monday-Friday Eastern Standard hours.** **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of ... interdepartmental teams, to assess medical necessity of care of member + Escalates prior authorization requests to Medical Directors as appropriate to determine… more
- Actalent (Sunrise, FL)
- …direct utilization and capture data effectively. Responsibilities + Review prior authorization requests for medical necessity and appropriateness, utilizing ... Utilization Management Nurse !Job Description The ...between the Medical Director, physicians, and office staff, resolving prior authorization issues. + Communicate denial determinations… more
- Actalent (Sunrise, FL)
- …satisfaction, safety, and appropriate length of stay. Responsibilities + Review prior authorization requests for medical necessity and appropriateness using ... Actalent is hiring a Utilization Management Nurse ! Job Description The...with the interdisciplinary team to perform reviews of service authorization requests, ensuring the utilization of appropriate… more
- Adecco US, Inc. (Minneapolis, MN)
- …or 5+ years nursing experience . Relevant experience in UM process activities such as prior authorization or medical claims review . Resides in Texas **Why work ... : $40.00 - $43.25 per hour based on experience **Responsibilities of the Utilization Management Nurse ** : . Responsible for reviewing proposed hospitalization,… more
- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA ... Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization ...+ Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical… 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:** + MUST ... + Do you have experience with Prior Authorization ? + Do you have experience with Utilization... Review? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech Solutions… more
- US Tech Solutions (Columbia, SC)
- …therapy experience + A typical day would like in this role: Process prior authorization requests for Medicare Advantage line of business. Previous Medicare ... to hire) **Job Description:** + NICE TO HAVE skill sets/qualities: Utilization management experience and /or Appeals experience /strong clinical skills Behavioral… more
- US Tech Solutions (May, OK)
- …hospital experience . Registered Nurse in state of residence . Must have prior authorization utilization experience . Able to work in multiple IT ... and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review. . MUST HAVE 1 YEAR OF...knowledge of Milliman/MCG. . MUST HAVE 6 months of Prior Authorization . Education: . Active and unrestricted… more
- AmeriHealth Caritas (LA)
- …clinical experience in home healthcare or a medical office setting. + Previous prior authorization experience is required.; + Proficiency in Electronic Medical ... direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient...Degree in Nursing (BSN) preferred. + An active Registered Nurse (RN) license in good standing is required. +… more
- CDPHP (Albany, NY)
- …responsible for the clinical review and documentation for services requiring prior authorization . This includes approval determinations and appropriate ... of acute care experience is required as a Registered Nurse . + Minimum of two (2) years Utilization... Nurse . + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of coding/claims… more
- CVS Health (Richmond, VA)
- …to work Monday-Friday, 8 AM-5 PM, with occasional on-call duties **Preferred:** + Prior authorization experience + BSN degree + Virginia residency or compact ... all with heart, each and every day. **Position Summary** The Utilization Management (UM) Nurse Consultant is a remote, full-time role responsible for evaluating… more
