- 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 ... Carry out accurate and timely retrospective (post-service) reviews for services requiring prior authorization but not obtained by the provider before service… more
- BioSpace (Rockaway, NJ)
- …to the position. We encourage employees to discuss the opportunity with their supervisor prior to applying. TERRITORY MANAGER - HACKETTSTOWN NJ CMH2_170846 The ... qualifications outlined in the job description and have/obtain work authorization in the country the position is located in...We encourage employees to discuss the opportunity with their supervisor prior to applying. Lilly is an… more
- Humana (Madison, WI)
- …specifically Word, Excel, and Outlook. + At least 3-years experience with prior authorization / utilization management. **Preferred Qualifications** + ... and help us put health first** The UM/PA Nurse Supervisor plays a key leadership role in overseeing the...leadership role in overseeing the daily operations of the Utilization Management and Pre- Authorization nursing teams. This… 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 Proposed ... health care delivery. What we want The Registered Nurse II- Prior Authorization and Referral, under general supervision,...experience in at least one of the following areas: Prior authorizations or utilization management , c… more
- Actalent (Sunrise, FL)
- …direct utilization and capture data effectively. Responsibilities + Review prior authorization requests for medical necessity and appropriateness, utilizing ... a liaison between the Medical Director, physicians, and office staff, resolving prior authorization issues. + Communicate denial determinations to providers when… 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 ... 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager...Knowledge, Skills & Abilities (must have):** + Experience with prior authorization and retrospective reviews + Proficiency… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …advocate between Dana Farber Cancer Institute and various health plans. Reporting to the Prior Authorization Supervisor , the Clinical Authorization ... be overturned. + Appropriately escalates complex cases to Drug Authorization Supervisor or Manager of Prior...year of clinical and/or related experience required. Case Management, Utilization Review and/or Prior Authorization … more
- AmeriHealth Caritas (LA)
- …clinical experience in home healthcare or a medical office setting. + Previous prior authorization experience is required.; + Proficiency in Electronic Medical ... **Responsibilities:** Under the direction of a supervisor , the Clinical Care Reviewer - Utilization...a supervisor , the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient… more
- Dignity Health (Rancho Cordova, CA)
- …and the appropriate application of policies and guidelines to Managed Care prior authorization referral requests. Under general supervision this position is ... Summary:** Under the guidance and supervision of the department Manager/Director the Supervisor of Utilization Management is responsible and accountable for… more
- ChenMed (Winter Park, FL)
- …rapidly expanding and we need great people to join our team. The Supervisor , Intensive Community Care, RN is a multi-market leadership position responsible for ... guidance to their team. Directly reporting to the Manager of ICC, this Supervisor is responsible for their teams members assigned patient case load whose role… more
- ASM Global (Houston, TX)
- …north dock at NRG Stadium and NRG Center. + Ensuring all shipments received have prior authorization and verifying with the tenant any shipmentswithout prior ... has an excellent and immediate opening for a Dock Supervisor at NRG Park in Houston, Texas. NRG Park...Standards, applicable local codes and NFL's Best Practices. + Utilization of a variety of technological software, platforms, and… more
- Molina Healthcare (Savannah, GA)
- …this family include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns ... and comply with CMS guidelines. These staff may also be involved in providing utilization management/ prior authorization services as needed. * Supervises the… more
- Mohawk Valley Health System (Utica, NY)
- …SNH is responsible for the oversight of the case management staff's authorization /coordination/ utilization and provision of member services. Duties include the ... RN Supervisor Case Management - Full Time - Days...direct oversight of the case manager's daily operations of utilization review practice, processes and procedures ensuring accurate member… more
- MyFlorida (Spring Hill, FL)
- DOCUMENT SPECIALIST SUPERVISOR - SES - 64041156 1 Date: Jul 22, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify ... 857224 Agency: Department of Health Working Title: DOCUMENT SPECIALIST SUPERVISOR - SES - 64041156 1 Pay Plan: SES...back up to Medical Records Tech, process medical records, authorization to disclose. HMS clinic schedule maintenance. Patient Flow… more
- Nobis Works (Atlanta, GA)
- Job Descriptions: Position Summary: The Supervisor , Youth Educational Services will oversee day-to-day operations of Tommy Nobis Centers Early Youth Employment ... at the highest level of quality, + Responsible for acquiring service authorization and maintaining adequate reporting records for each individual receiving services.… more
- Air National Guard Units (Birmingham, AL)
- …SERVICE POSITION. This National Guard position is for a AIRCRAFT MAINTENANCE SUPERVISOR (T32), Position Description Number D1444000 and is part of the AL 117TH ... economical and efficient work operations. Analyzes production, cost and personnel utilization records and makes adjustment in operations to correct problems.… more
- Guidehouse (Ojai, CA)
- …**What You Will Do** **:** **Supervisory Responsibilities:** Patient Access Supervisor supervises employees and operations within the Admitting, Emergency Admitting ... complaints and resolving problems. + Implements departmental organization through the Utilization and maintenance of schedules and the adherence to Human Resources… more
- Air National Guard Units (Eielson AFB, AK)
- …Air National Guard. PDCN: D2180P01 / D2181P01 MPCN: 889707 Selecting Supervisor : James Meyer Responsibilities GS-09 - Administers classified and unclassified local ... and software and develops base wide network operating procedures. Analyzes LAN utilization statistics through data collection and performance measures to ensure the… more
- Veterans Affairs, Veterans Health Administration (Miami, FL)
- …follows a capabilities model to achieve goals for eligibility, referral and authorization , care coordination, and utilization management to ensure improved ... improving the Veteran's experience and outcomes. Defines mental health policies, utilization management process and procedures, financial and utilization reports… more
- Air National Guard Units (Reno, NV)
- …is to perform preliminary planning and long term forecasting of utilization of aerospace vehicles, engines, and associated support equipment. Responsibilities 1. ... for advising, planning and coordinating aircraft maintenance requirements and utilization scheduling between maintenance, operations, and external organizations. Actively… more
