- Centene Corporation (Cheyenne, WY)
- …5pm Pacific, with occasional weekends and holidays. **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service and ... the United States. This position does require an Oregon RN or LPN license. The work schedule for the...assess medical necessity of care of member + Escalates prior authorization requests to Medical Directors as… 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
- 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
- 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
- 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
- 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
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse ( RN ) Manager,...Knowledge of Coordination of Care, Medicare and Medi-Cal regulations, prior authorization , level of care and length ... + Excellent verbal, written communication and presentation skills. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and… more
- University of Washington (Seattle, WA)
- …Medical Center-Northwest Heart Institute** has an outstanding opportunity for an **Intermittent Registered Nurse ( RN )** to join our **Cardiology Clinic.** ... to coordinate continuity of patient care. + Supports the prior authorization process for prescribed medications. +...patient. **REQUIREMENTS** + Active, valid Washington State or Multi-State RN license required by start date. + 2 years… more
- Beth Israel Lahey Health (Newburyport, MA)
- …cancer committee membership and other department level committees. Phone triage, prior authorization and coordination of patient appointments from office ... accredited nursing program. BSN preferred. Required Licenses + [Massachusetts, United States] Registered Nurse + Must be currently licensed as a Registered … more
- Great River Health (Mount Pleasant, 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
- Sharp HealthCare (La Mesa, CA)
- …**Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA Board of Registered ... care nursing experience or case management experience. + California Registered Nurse ( RN ) - CA...services are directed to appropriate network providers, and obtains prior authorization for in network and out… more
- Adecco US, Inc. (Minneapolis, MN)
- …authorizations submitted by providers within the designated turnaround times specified in the Prior Authorization List for all lines of business, including RMHP ... RMHP IFP, and NHP RAE Medicaid + When processing authorization requests, the Clinical Coordinator applies approved medical necessity...independent licensure as a LAC, LPC, LMFT, LSCW, or RN **in Colorado** + 4+ years directly serving individuals… 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)
- …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)
- …your future. **Responsibilities** Location: Mary Brigh Building, St. Marys Hospital Campus The Registered Nurse ( RN ) in the Radiology Pre/Post will use ... of experience, will receive an extensive orientation program. 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)
- …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)
- …expenses. + Retirement: Competitive retirement package to secure your future. **Responsibilities** **The registered nurse ( RN ) in the Internal Travel Team at ... be assigned to PCU or Med/Surg work units. The registered nurse ( RN ) is accountable...working in a team environment. + Computer skills required, prior experience with electronic medical record systems preferred. +… more
- Molina Healthcare (Rio Rancho, NM)
- …, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... stay for requested treatments and/or procedures. * Conducts reviews to determine prior authorization /financial responsibility for Molina and its members. *… more
- Molina Healthcare (North Las Vegas, NV)
- …, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... stay for requested treatments and/or procedures. * Conducts reviews to determine prior authorization /financial responsibility for Molina and its members. *… more