- Mindful Care (New York, NY)
- We are seeking Board Certified Psychiatric Mental Health Nurse Practitioners (PMHNP) to expand access to behavioral health care in your area. If you're passionate ... while maintaining control over their schedule. We handle patient scheduling, prior authorizations, case management, billing, and other support functions. Our… more
- Network Health WI (Menasha, WI)
- …principles, procedures, requirements, regulations, and policies Evaluate and process prior authorization requests/referrals submitted from contracted and ... The RN Coordinator Utilization Management reviews submitted authorization requests... (RN) required Experience in insurance, managed care, and utilization management preferred Current Registered Nurse (RN)… more
- KMA Human Resources Consulting (South Portland, ME)
- …clinical direction for patients when their physicians are unavailable. Participates in utilization review and prior authorization requests. Supports ... Chest Medicine Associates Physician Assistantor Nurse Practitioner South Portland, Maine Chest Medicine Associates...Chest Medicine Associates is seeking a Physician Assistant or Nurse Practitioner to be based in the South Portland… more
- Carle Health (Urbana, IL)
- …with 1 or more years experience - External Applicants Only The staff Registered Nurse (RN) is a professional caregiver who assumes responsibility for a group of ... a designated time frame and provides care to these patients via the utilization of the nursing process, nursing trends, technology, financial and human resources… 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 ... team-based health care delivery. What we want The Registered Nurse II- Prior Authorization and Referral,...experience in at least one of the following areas: Prior authorizations or utilization management , c… more
- Centene Corporation (New York, NY)
- …**8:30am-5pm, Monday-Friday Eastern Standard hours.** **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of ... interdepartmental teams, to assess medical necessity of care of member + Escalates prior authorization requests to Medical Directors as appropriate to determine… 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
- Actalent (Sunrise, FL)
- …satisfaction, safety, and appropriate length of stay. Responsibilities + Review prior authorization requests for medical necessity and appropriateness using ... Actalent is hiring a Utilization Management Nurse ! Job Description The...with the interdisciplinary team to perform reviews of service authorization requests, ensuring the utilization of appropriate… more
- Adecco US, Inc. (Minneapolis, MN)
- …or 5+ years nursing experience . Relevant experience in UM process activities such as prior authorization or medical claims review . Resides in Texas **Why work ... : $40.00 - $43.25 per hour based on experience **Responsibilities of the Utilization Management Nurse ** : . Responsible for reviewing proposed hospitalization,… more
- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA ... Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization ...+ Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical… more
- US Tech Solutions (Chicago, IL)
- …as an RN + Registered Nurse in state of residence + Must have prior authorization utilization experience + Experience with Medcompass **Skills:** + MUST ... + Do you have experience with Prior Authorization ? + Do you have experience with Utilization... Review? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech Solutions… more
- US Tech Solutions (Columbia, SC)
- …therapy experience + A typical day would like in this role: Process prior authorization requests for Medicare Advantage line of business. Previous Medicare ... to hire) **Job Description:** + NICE TO HAVE skill sets/qualities: Utilization management experience and /or Appeals experience /strong clinical skills Behavioral… more
- US Tech Solutions (May, OK)
- …hospital experience . Registered Nurse in state of residence . Must have prior authorization utilization experience . Able to work in multiple IT ... and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review. . MUST HAVE 1 YEAR OF...knowledge of Milliman/MCG. . MUST HAVE 6 months of Prior Authorization . Education: . Active and unrestricted… more
- AmeriHealth Caritas (LA)
- …clinical experience in home healthcare or a medical office setting. + Previous prior authorization experience is required.; + Proficiency in Electronic Medical ... direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient...Degree in Nursing (BSN) preferred. + An active Registered Nurse (RN) license in good standing is required. +… more
- CDPHP (Albany, NY)
- …responsible for the clinical review and documentation for services requiring prior authorization . This includes approval determinations and appropriate ... of acute care experience is required as a Registered Nurse . + Minimum of two (2) years Utilization... Nurse . + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of coding/claims… more
- CVS Health (Richmond, VA)
- …to work Monday-Friday, 8 AM-5 PM, with occasional on-call duties **Preferred:** + Prior authorization experience + BSN degree + Virginia residency or compact ... all with heart, each and every day. **Position Summary** The Utilization Management (UM) Nurse Consultant is a remote, full-time role responsible for evaluating… more
- Humana (Madison, WI)
- …specifically Word, Excel, and Outlook. + At least 3-years experience with prior authorization / utilization management. **Preferred Qualifications** + ... community and help us put health first** The UM/PA Nurse Supervisor plays a key leadership role in overseeing...leadership role in overseeing the daily operations of the Utilization Management and Pre- Authorization nursing teams. This… 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
- Commonwealth Care Alliance (Boston, MA)
- …Required Knowledge, Skills & Abilities (must have): * Expertise in managing utilization review processes including prior authorization , concurrent and ... for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff...Management * Oversees clinical decision review for services requiring prior authorization in a variety of clinical… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …clinical background within a managed care setting including a high-level understanding of prior authorization process from beginning of ingestion at Intake level ... About The Role The Director, Utilization Management (UM) will manage the Utilization...Qualifications + Active and unrestricted license as a Registered Nurse (RN). + Bachelor's degree in nursing, (or equivalent… more
