- AltaMed Health Services Corporation (Montebello, CA)
- …a Licensed Vocational Nurse. Minimum of 2 years of managed care experience in Utilization Management / prior authorization required. A minimum requirement ... drives us forward every day. Job Overview The LVN Utilization Management Nurse (UM Nurse) will provide... Nurse (UM Nurse) will provide routine review of authorization requests from all lines of business using respective… more
- Health eCareers (Los Angeles, CA)
- …to insurance companies for prior authorizations creating discharge delay. Case Management and Utilization Review: Supports the overall enterprise of the Case ... and Utilization Review leads the hospital specific execution of the Case Management (CM) and Utilization Management (UR) and related activities. The… more
- NCH Healthcare System (Naples, FL)
- …service arrangements, processing, organizing, and obtaining insurance verification and/or prior authorization from insurance companies for discharge ... community resources to coordinate discharge transition plans. . Collaborates with the utilization management team to ensure that appropriate CMS regulatory… more
- Sonder Health Plans, Inc. (Atlanta, GA)
- …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
- NY CREATES (Albany, NY)
- …SUMMARY The Manager of Device Integration will be responsible for engineering and management of the NY CREATES Integration and Device Engineering group in support of ... business opportunities with existing and new customers, IP creation and management , and professional development of the Integration and Device Engineering Team.… more
- Curative HR LLC (Austin, TX)
- …5 years of clinical practice experience. Minimum of 2-3 years of experience in utilization management , medical review, or prior authorizations within an ... expertise, established medical policies, and evidence-based guidelines. Conduct thorough prior authorization reviews, ensuring alignment with clinical criteria,… more
- Actalent (Chicago, IL)
- …In this role, you will utilize your clinical skills to conduct utilization management reviews, including prior authorizations, coverage exceptions, ... with contracts evaluated every six months for extension. Responsibilities Conduct utilization management reviews, including prior authorizations, coverage… more
- Monster (Morristown, NJ)
- …for Health Care Providers (HCPs) and Patients. Payer medical and pharmacy Utilization Management (UM) criteria create process delays for patients like ... required Benefits Investigations (BI), Prior Authorization (PA), Denial Appeals, detailed Clinical...local and national payer landscape, including Specialty Pharmacy and Utilization Management criteria for TZIELD Reactively address… more
- UnitedHealth Group (Grand Junction, CO)
- …authorizations submitted by providers within the designated turnaround times specified in the Prior Authorization List for all lines of business, including RMHP ... to work Monday - Friday, 930am-6pm Mountain Standard Time Preferred Qualification: Utilization Management experience *All employees working remotely will be… more
- CenCal Health (Santa Barbara, CA)
- …CCM, CMCN, CPHQ, HCQM, CPUM, CPUR, or board certification in an area of specialty. Prior experience in Utilization Management (UM) within a managed care ... Job Summary The Health Plan Nurse Coordinator - Adult Utilization Management (HPNC - Adult UM) is...accurate and timely prospective (pre-service) reviews for services requiring prior authorization . Perform timely concurrent reviews for… more
- NY CREATES (Albany, NY)
- …Job responsibilities include but are not limited to: Virtual Machine Management : Creating, configuring, and managing virtual machines on virtualization platforms ... managing storage infrastructure (SAN, NAS, DAS). Monitoring storage capacity utilization and proactively managing storage expansion. Implementing data protection… more
- Mindful Care (Hoboken, NJ)
- …care while maintaining control over their schedule. We handle patient scheduling, prior authorizations, case management , billing, and other support functions. ... Our model emphasizes supportive therapy and non-stimulant or non-narcotic medication management for our patients. Your Qualifications: Completion of a Master's… more
- NYC Health Hospitals (New York, NY)
- …including restricted drugs and any required drug request documentation. Understands prior authorization process for insured patients and is responsible ... 8:00 AM - 4:30 PM Job Description Purpose: The Collaborative Drug Therapy Management (CDTM) Pharmacist partners with the Office of Ambulatory Care and collaborating… more
- Stratis Group (Fort Worth, TX)
- …awareness during the entire access process which may include formulary coverage/ utilization management criteria, coding, insurance forms & procedures, benefits ... investigation, prior authorization , appeal, and/or claims resolution. Educate...Sales (Specialty or Biologics), or healthcare provider office practice management 4-year degree in related field or equivalent experience… more
- South Florida Regional Transportation Authority (Pompano Beach, FL)
- …our team. Under the direction of the Executive Director, this Senior Management position is responsible for the complete oversight and contract administration of ... Florida! Essential Duties & Additional Responsibilities Contract & Vendor Management : Lead a team of professionals to ensure SFRTA's...the South Florida Rail Corridor to achieve the best utilization of the Rail corridors over which SFRTA operates.… more
- Regal Medical Group, Inc. (Northridge, CA)
- …Medical Director specific to Cal MediConnect members. Focus on Cal MediConnect and Exchange utilization management . Will also perform prior auth function for ... management services. Essential Duties and Responsibilities include the following: Prior Authorization : Understand, promote and manage with the principles of… more
- Qualderm (Livonia, MI)
- …insurance eligibility, financial status and assigns correct payor type. Verifies if prior authorization from insurance is required; notifies Billing Department, ... on the telephone, answering or referring inquiries. Notes patient arrival in Practice Management System (EMR). Identifies patients by date of birth and name in… more
- Regal Medical Group, Inc. (Northridge, CA)
- …appropriately and clearly with physicians, in patient case managers and Prior - Authorization nurses Identifies and addresses psychosocial needs of the ... and communicate with all members of the healthcare team (concurrent review, pre- authorization , PCP, SPC, Social Services, and Pharmacy) to coordinate the continuum… more
- University of Massachusetts Medical School (Shrewsbury, MA)
- …for administering client-specific programs to provide clinical expertise in regards to prior authorization for member prescriptions and client member's drug ... IV functions as a team member of the drug utilization review and medication management therapy programs...appropriate drug therapy, coordinating and managing the request for prior authorization process, and participating in the… more
- LHC Group, Inc. (Nutley, NJ)
- …therapist(s) assignments for timely patient evaluation by signing off after authorization and plotting start of care (SOC) visits. Coordinates determination of ... agency services as indicated by the physician. Receives report from field clinicians prior to scheduled days off on patient status and ongoing needs. Processes new… more
