- UnitedHealth Group (Aurora, IL)
- …RN license Bariatric experience as the main focus of your job Prior Authorization / Utilization Management /Review experience Post-surgical experience ... us to start Caring. Connecting. Growing together. The Bariatric Prior Authorization RN Case Manager is responsible...Case Manager is responsible for clinical operations and medical management activities across the continuum of care for members… more
- Riverside County, CA (Moreno Valley, CA)
- …referrals, medical necessity, admission/discharge/ transfer process, and other utilization management activities; develop performance improvement plans; ... to reduce length of stay and to optimize quality outcomes that balance utilization management and fiscal reimbursement; develop and implement action plans to… 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
- Blue Shield of California (Oakland, CA)
- Job Description Your Role The Behavioral Health Utilization Management team performs prospective & concurrent utilization reviews and first level ... recognized clinal criteria across multiple lines of business. The Behavioral Health Utilization Management Clinician, Experienced, will report to the Manager of… more
- Molina Healthcare (Long Beach, CA)
- …include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... with CMS guidelines. These staff may also be involved in providing utilization management / prior authorization services as needed. *Supervises the unit's… more
- Blue Shield of California (Oakland, CA)
- …claims dispute reviews. The Senior Medical Director for FEP Prior Authorization and Post Review facilitates performance management and goals in alignment ... care system in California. The Senior Medical Director FEP Prior Authorization and Post Review will report...management of the physician processes in support of utilization management and transactional functions for Federal… more
- Baton Rouge General (Baton Rouge, LA)
- …with experience collaborating across multidisciplinary teams Demonstrated experience in utilization review, precertification, or case management Proficiency in ... proper documentation and timely communication Communicate with Care Coordinators and Pre- Authorization Coordinators to ensure streamlined case management Send… 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
- Molina Healthcare (Long Beach, CA)
- …include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... KNOWLEDGE/SKILLS/ABILITIES Performs initial receipt and review of non-formulary or prior authorization requests against plan approved criteria. Requests… more
- Intermountain Healthcare (Salt Lake City, UT)
- …Coordinates, manages, and monitors pharmacy claims processing services, utilization management , and prior authorization protocols. Conducts Drug ... Essential Functions Ensures coordination and communication of pharmacy benefit management (PBM) programs including drug manufacturer contracting, P&T Committee… more
- Highmark Health (Wexford, PA)
- …Job Description : JOB SUMMARY This position supports the network centralized prior authorization department. Coordinates and administers the effective and ... efficient processing of the pharmacy benefits prior authorization process, ensuring that pharmacy benefits are administered in accordance with all regulatory… more
- US Tech Solutions (Schenectady, NY)
- …of experience as an RN Registered Nurse in state of residence Must have prior authorization utilization experience Experience with Medcompass Skills: MUST ... exp and Medicare/Medicaid knowledge. MUST HAVE UM experience, inpatient utilization management review. MUST HAVE 1 YEAR...Medcompass? Do you have experience with Prior Authorization ? Do you have experience with Utilization … more
- UnitedHealth Group (Metairie, LA)
- …the performance of utilization management including the Inpatient Care Management team and Clinical Coverage Review team ( prior authorization ), ... The health plan CMO will work collaboratively in these activities with utilization management medical directors and regional CMOs. The Health Plan… more
- St. Luke's University Health Network (Lehighton, PA)
- …for admission and/or referral to appropriate level of care. May assist in the utilization management of psychiatric cases in the absence of the utilization ... and the Manager regarding variances, aspects of patient care management . Facilitates insurance authorization , pre-certification, and concurrent reviews… more
- Discovery Behavioral Health (Portland, OR)
- …members of the clinical team in their absence. Communicates with the Utilization Review Department and Business Department regarding authorization and payment. ... facilitate clinical assessments, conduct therapy sessions, and other case management tasks, as assigned. Responsibilities Ensures clinical documentation is completed… more
- Federal Aviation Administration (Atlanta, GA)
- …certificate design approvals from domestic, foreign and Organization Designation Authorization (ODA) applicants. Determines the overall safety of proposed aircraft, ... areas requiring issue papers, general acceptability of proposals, resource utilization , and applicability of the proposed certification schedules. Uses experience… more
- City of Coronado, CA (Coronado, CA)
- …sewer mainline rehabilitation and storm drain rehabilitation; determine work assignments and utilization of staff, equipment, and materials; and train staff on work ... the street sweeping program, evaluate effectiveness, and suggest changes to management as needed. Supervise related environmental and compliance permits, programs,… more
- ADELANTE HEALTHCARE INC (Goodyear, AZ)
- …with patients to develop self- management goals, provide insurance, referral, and prior authorization support, and may also conduct patient outreach to follow ... Prepare for the patient appointment by reviewing and updating patient records prior to patient arrival Interview patient to obtain reason for visit: chief… 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
- D-H Lebanon-MHMH (Lebanon, NH)
- …surgical procedures. Notifies Clinic Administration concerning changes in patient insurance or authorization status prior to date of surgery. Coordinates and ... billing staff and provide any necessary documentation needed to obtain prior insurance authorizations and pre-certifications for lab testing, physician appointments… more
