- Blue Shield of California (Rancho Cordova, CA)
- …with members care including clinical nurses and treating MDs. The Case Management Nurse , Senior will report to the Manager, Care Management. In this role you ... plan in cases of member inquiry, triage hub, chronic conditions, polypharmacy, pre -natal care, and voluntary member health assessment, in addition to indication of… 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 ... acute clinical nursing experience *Active Georgia Registered Nursing license * Pre - authorization and Concurrent review experience *Medical record investigative… more
- CenCal Health (Santa Barbara, CA)
- …medical necessity of requested services. Conduct accurate and timely prospective ( pre -service) reviews for services requiring prior authorization . Perform timely ... Coast Salary Range: $84,877 - $123,072 Annually Job Summary The Health Plan Nurse Coordinator - Adult Utilization Management (HPNC - Adult UM) is a Registered… more
- Mary Washington Healthcare (Bowling Green, VA)
- …to review and sign. Works with third party payors to obtain authorization / pre -certification for surgeries, diagnostic testing, and other procedures ordered by ... flow throughout the office. Assists Physician, Physician Assistant, or Nurse Practitioner with examinations, diagnostic procedures and treatments. Obtains patient… more
- Riverside County, CA (Moreno Valley, CA)
- …night shift, 1900 - 0730 Additional Differentials: Evening Shift (6:00pm to 11:00pm): $ 2 .50 per hour Night Shift (11:00pm to 7:30am): $5.00 per hour ED Critical ... Care: 0- 2 years experience $4.00 per hour, 3-5 years experience...reviews; act as a team leader or relief charge nurse . *Assign and monitor, the work of subordinate nursing… more
- Marion County, OR (Salem, OR)
- …as this recruitment may close at any time without further notice. Are you a registered nurse who is looking to work in a fast paced outpatient setting? Do you enjoy ... injections, providing support to our team of psychiatrists and psychiatric nurse practitioners, and coordinating care and medications for individuals in service.… more
- Southern Illinois University School of Medicine (Springfield, IL)
- …clinic setting. Sign-On Bonus: Now offering a $7,500 sign-on bonus with a 2 -year employment commitment for candidates identified for hire before December 31st, 2025! ... provider, and obtaining any relevant lab and x-ray reports prior to the visit. 2 . Prepares for clinic by ensuring required information is available at time of… more
- UNC HEALTH (Raleigh, NC)
- …Medical Center. They provide patients with consultations for treatment of pre -invasive and invasive gynecologic cancers as well as complicated gynecologic disorders. ... criteria. If indicated, communicate with Care Management Assistant (CMA) to share priorities. 2 . CAPP Meeting - Attend and actively participate in CAPP meetings for… more
- UHS (Palmdale, CA)
- …and teammates. Calculates patient liability for hospital admissions and/or pre -scheduled procedures and forward patient estimates to the facilities Financial ... High School Graduate or equivalent required. One (1) to Two ( 2 ) years' years of experience in patient registration and/or insurance and… more
- Blue Cross and Blue Shield of Minnesota (St. Paul, MN)
- …implements effective utilization management strategies including: review of appropriateness of pre and post service health care services, application of criteria to ... experience, health plan benefit structure and claims payment knowledge to pre - service and retrospective reviews by gathering relevant and comprehensive clinical… more
- Amberwell Health (Atchison, KS)
- …Atchison, KS Position Type PRN (As needed - no set schedule) Education Level 2 Year Degree Travel Percentage Travel Between Amberwell Locations Job Shift Day Job ... and quality of care and communicates those findings. Performs pre -certification, certification, and re-certification of patients charts associated with external… more
- Humana (Madison, WI)
- …role in overseeing the daily operations of the Utilization Management and Pre - Authorization nursing teams. This position ensures timely and accurate review ... Provide daily operational support and guidance to Utilization Management (UM) and Pre - Authorization (PA) nursing staff. + Conduct monthly one-on-one check-ins… 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 ... research and team-based health care delivery. What we want The Registered Nurse II-Prior Authorization and Referral, under general supervision, manages… more
- Select Medical (Columbus, OH)
- …doing what is right. As the Payor Relations Specialist, you will manage the pre -certification and prior authorization of referrals scheduled for admission to our ... Payors -_** + Initiates and completes patient authorizations. + Obtains timely authorization of all patients requiring pre -certification and is accountable for… more
- Trinity Health (Hartford, CT)
- …Type:** Full time **Shift:** Day Shift **Description:** **Position Purpose** The Clinical Pre -Service Nurse Coordinator is directly responsible for reviewing ... / Licensed Practical Nurse (LVN/LPN) and/or a Nurse Compact License NLC + Two ( 2 )...( 2 ) years of nursing experience and two ( 2 ) years of pre -certification/prior approval clinical denial… more
- St. Luke's University Health Network (Fountain Hill, PA)
- …a patient's ability to pay for health care. The Critical Care Transport (CCT) Pre -Hospital Registered Nurse (PHRN) is responsible for the direct patient care and ... CCT PHRN will report directly to the CCT Program Nurse Manager, and under the authorization of...the State of New Jersey. + Currently possesses a Pre -hospital Registered Nurse (PHRN) through the Pennsylvania… more
- Providence (Portland, OR)
- …documentation, conferencing with the referral source, the Pharmacist, Infusion Nurse Coordinator and other key stakeholders; and verifying insurance eligibility ... and benefits; cost of medication, obtaining pre -authorizations and re-authorizations and assisting patients with copay and financial assistance. This position is… more
- Mayo Clinic (Eau Claire, WI)
- …for flexible coverage. + Vision: Affordable plan with national network. + Pre -Tax Savings: HSA and FSAs for eligible expenses. + Retirement: Competitive retirement ... package to secure your future. **Responsibilities** Wishart 2 is our newest Eau Claire based medical/surgical unit....skills building strong collaboration within the team. The registered nurse (RN) is accountable for the coordination of nursing… more
- Veterans Affairs, Veterans Health Administration (Perry Point, MD)
- …AND 2 years of professional nursing experience in which one year is equivalent to Nurse I, Level 2 ; OR a BSN and 1 year of professional nursing experience ... for the coordination of the medical center's community care authorization program. He/she functions as part of the interdisciplinary...equivalent to the Nurse I, Level 2 ; OR a Master's… more
- Veterans Affairs, Veterans Health Administration (Leavenworth, KS)
- …AND 2 years of professional nursing experience in which one year is equivalent to Nurse I, Level 2 ; OR a BSN and 1 year of professional nursing experience ... equivalent to the Nurse I, Level 2 ; OR a Master's degree in nursing (MSN) and no additional professional nursing experience; OR a Master's degree in a *related… more
