- 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
- Molina Healthcare (Long Beach, CA)
- …appropriate benefits and eligibility for requested treatments and/or procedures. Conducts prior authorization reviews to determine financial responsibility for ... and its members. Processes requests within required timelines. Refers appropriate prior authorization requests to Medical Directors. Requests additional… 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
- Sharp HealthCare (La Mesa, CA)
- …referrals for care and services are directed to appropriate network providers, and obtains prior authorization for in network and out of network services as ... position requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving care… more
- The Jane Pauley Community Health Center, Inc (Indianapolis, IN)
- …and/or as recommended by medical providers. Performs medication refills and prior authorization . Documents timely, consistently, and thoroughly of patients' ... to the Patient-Centered Medical Home and Medical Neighborhood initiatives. As a Nurse Preceptor: Participates in precepting newly hired clinical staff or nursing… more
- Reef Systems (Montgomery, AL)
- …Staff (ProStaff) meetings. Identify and notify the Government MTF case manager, Utilization Management (UM) nurse or Primary Care Management (PCM) team, ... Licensed Practical Nurse (LPN) - Maxwell AFB, AL Reef Systems...MTF PRP monitor). Verify appropriate paperwork is on file prior to authorization . Customer Service Function :… 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
- Centene Corporation (New York, NY)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service ... 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)
- …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
- CVS Health (Oklahoma City, OK)
- …+ Experience in ** utilization management** , **precertification** , or ** prior authorization ** + Background in **managed care** **Education** + **Associate's ... with a requirement to **reside in Oklahoma** . The nurse in this position uses clinical expertise in a...the quality and effectiveness of healthcare services and benefit utilization . This position requires close review of both handwritten… 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
- CVS Health (Baton Rouge, LA)
- …4 hours a day working with providers to secure additional information for prior authorization review. This candidate will utilize clinical skills to coordinate, ... ( utilization management) experience within an **outpatient** setting, concurrent review or prior authorization . + 5 years of a variety clinical experience… 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 (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
- 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
- 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
- CVS Health (Tallahassee, FL)
- …with Microsoft Office Applications (Outlook, Teams, Excel) **Preferred Qualifications** + Prior authorization utilization experience preferred + Outpatient ... and work schedule may include weekends, holidays, and evening hours._ **UM Nurse Consultant** Fully Remote- WFH **Position Summary** + Utilizes clinical experience… 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
- CVS Health (Annapolis, MD)
- …of residence. + 3+ years of Nursing experience. Preferred Qualifications + Prior authorization utilization management/review experience preferred Outpatient ... and external constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications + Registered Nurse in… more
