- CVS Health (Annapolis, MD)
- …state of residence. + 3+ years of Nursing experience. Preferred Qualifications + Prior authorization utilization management /review experience preferred ... and external constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications + Registered Nurse in… more
- Elevance Health (Woodbridge, NJ)
- …assess provider satisfaction. Assessment shall include provider experiences with claims processing, prior authorization , utilization management , and ... **Clinical Quality Management Analyst Sr. Behavioral Health** **Location:** 111 Wood...(HCQM) by the American Board of Quality Assurance and Utilization Review Physicians. **Preferred Skills, Capabilities & Experiences:** +… more
- CVS Health (Pittsburgh, PA)
- …and ongoing departmental and enterprise initiatives. Knowledge of utilization management interventions including prior authorization , step therapy, ... or prior authorization experience - Demonstrated understanding of utilization management interventions including prior authorization , step… more
- Centene Corporation (Jefferson City, MO)
- …**Position Purpose:** Oversee operations of the referral management , telephonic utilization review, prior authorization , and various related functions ... Committee for Quality Assurance (NCQA) standards for utilization management functions, prior authorization and concurrent review units + Collaborate with… more
- CVS Health (Oklahoma City, OK)
- …in ** utilization management ** , **precertification** , or ** prior authorization ** + Background in **managed care** **Education** + **Associate's ... to improving the quality and effectiveness of healthcare services and benefit utilization . This position requires close review of both handwritten and digital… more
- US Tech Solutions (LA)
- …walls of a hospital setting in a specialty area of the nursing field providing utilization management prior authorization reviews. Build strong direct ... Minimum 3 years nursing experience with a minimum of 1 year in utilization management / prior authorization review experience. **Experience** : … 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
- Adecco US, Inc. (Phoenix, AZ)
- A Prior Authorization Pharmacist position is now available through Adecco Healthcare and Life Science. The essential functions of a Pharmacists in Prior ... Authorization are reviewing Prior Authorization cases and rendering coverage determinations based on clinical criteria and plan design in a fast paced and… more
- CareOregon (Portland, OR)
- …policies and procedures regarding Pharmacy Department functions including medication therapy management , DUR programs, medication prior authorization , and ... Nevada, Texas, Montana, or Wisconsin. Job Title Pharmacy Clinical Coordinator - ( Prior Authorization ) - Contingent Exemption Status Exempt Department Pharmacy… more
- Commonwealth Care Alliance (Boston, MA)
- …CCA-Auth & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Utilization Management ( Authorization ) Unit is primarily responsible for ... under the provisions of CCA's benefits plan. The Manager, Utilization Management is responsible for overseeing and...Skills & Abilities (must have): * Expertise in managing utilization review processes including prior authorization… 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 ... assess medical necessity of care of member + Escalates prior authorization requests to Medical Directors as...Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. NYS RN license… more
- Actalent (Sunrise, FL)
- Actalent is hiring a Utilization Management Nurse! Job Description The Utilization Management Nurse (UMN) collaborates closely with the interdisciplinary ... safety, and appropriate length of stay. Responsibilities + Review prior authorization requests for medical necessity and...activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management … more
- Molina Healthcare (Bellevue, WA)
- …are seeking a candidate with a WA state LPN licensure. Candidates with case management , Utilization Management (UM), and direct managed care experience are ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
- CVS Health (Baton Rouge, LA)
- … management ) experience within an inpatient, concurrent review or prior authorization . + Remote work experience. **Education** + Associate degree ... is URAC accredited in Case Management , Disease Management and Utilization Management . AHH...day working with providers to secure additional information for prior authorization review. This candidate will utilize… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) ... review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role...+ Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical… more
- Adecco US, Inc. (Minneapolis, MN)
- Adecco Healthcare & Life Sciences is hiring ** Utilization Management Nurses** ! This role is work from home and remote but we are requiring Nurses to live in ... $43.25 per hour based on experience **Responsibilities of the Utilization Management Nurse** : . Responsible for.... Relevant experience in UM process activities such as prior authorization or medical claims review .… more
- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Utilization Management Reviewer has a key role in ensuring CCA meets ... facilities under the provisions of CCA's benefits plan. The Utilization Management (UM) Reviewer is responsible for...* Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role The Director, Utilization Management (UM) will manage the Utilization Management team consisting of Clinicians and Non-Clinical support ... clinical background within a managed care setting including a high-level understanding of prior authorization process from beginning of ingestion at Intake level… more
- AdventHealth (Glendale Heights, IL)
- …AVE, Glendale Heights, IL 60139 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by ... including concurrent payer communications to resolve status disputes. The Utilization Management Nurse is accountable for a...payor authorization processes as required, ensuring proper authorization has been secured prior to or… more
- University of Rochester (Rochester, NY)
- …such as Medicaid Enrollment & Outreach, Financial Assistance, Registration and Insurance Management , Utilization Management , Social Work, Patient Accounts, ... Medical Records, Home Care Coordinators, Prior Authorization Teams, Contracting and Finance. +...experience REQUIRED. **KNOWLEDGE, SKILLS & ABILITIES** + Experience in management , operations, and leadership PREFERRED. + Requires a high… more