- HealthCare Support (Houston, TX)
- …systems. Verifies member eligibility, benefit coverage and facility contract status prior to processing authorization requests. Accurately enters the required ... Utilization Review RN HealthCare Support is actively seeking a...information into the managed care platform, adhering to UM policies and procedures. 5. Assists in the coordination… more
- UCLA Health (Los Angeles, CA)
- …is responsible for reviewing and evaluating clinical documentation related to prior authorization requests for medical services. The UM Review Nurse ... Description At UCLA Health, the Utilization Management ( UM ) Review Nurse plays a vital...of resources. Key Responsibilities: + Conducts clinical reviews of prior authorization requests to evaluate medical necessity… more
- Molina Healthcare (Boston, MA)
- …* At least 2 years experience, including experience in hospital acute care, inpatient review , prior authorization , managed care, or equivalent combination of ... a candidate with a MA RN licensure. Candidates with UM Medical Review background and experience using...requested treatments and/or procedures. * Conducts reviews to determine prior authorization /financial responsibility for Molina and its… more
- Humana (Schaumburg, IL)
- …and/or experience with medical terminology and/or ICD-10 codes. + Experience with Utilization Review and/or Prior Authorization , preferably within a managed ... Outlook **Preferred Qualifications** + A minimum of an Associate's degree. + Prior billing/claims or authorization experience + Proficient utilizing electronic… more
- Molina Healthcare (Orlando, FL)
- …family include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... clinical pharmacy services (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight (establishing… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …UM Coordinator is responsible for coordinating all aspects of the prior authorization process, including member eligibility and benefit verification, ... members of the organization. Primary Responsibilities + Research and confirm authorization requirements and communicate to member, providers, and facility staff. +… more
- CVS Health (AZ)
- …of 1 year of experience in Oncology and Transplant either in UM , concurrent review , or prior authorization + 3+ years of experience in Acute clinical ... the lives of patients facing complex medical journeys. As a Utilization Management ( UM ) Nurse Consultant specializing in Oncology and Transplant, you'll play a vital… more
- Molina Healthcare (Vancouver, WA)
- …2 years health care experience, including experience in hospital acute care, inpatient review , prior authorization , managed care, or equivalent combination ... stay for requested treatments and/or procedures. * Conducts reviews to determine prior authorization /financial responsibility for Molina and its members. *… more
- Molina Healthcare (Layton, UT)
- …benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina ... + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. +...Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management… more
- Molina Healthcare (Southaven, MS)
- …benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina ... + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. +...teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional travel to other… more
- LA Care Health Plan (Los Angeles, CA)
- …Preferred: Experience in Medi-Cal managed care. 1 year of experience in UM / Prior Authorization . Skills Required: Demonstrated proficiency in Medical ... support the safety net required to achieve that purpose. Job Summary The Authorization Technician II supports the Utilization Management ( UM ) Specialist by… more
- AdventHealth (Altamonte Springs, FL)
- …additional review as determined by department standards. Additionally, the UM RN is responsible for denial avoidance strategies including concurrent payer ... Facilitating precertification and payor authorization processes as required, ensuring proper authorization has been secured prior to or at the time of… 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 HAVE ... MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . +...knowledge of Milliman/MCG. + MUST HAVE 6 months of Prior Authorization . **Education:** + Active and unrestricted… more
- Molina Healthcare (Dayton, OH)
- …2 years health care experience, including experience in hospital acute care, inpatient review , prior authorization , managed care, or equivalent combination ... stay for requested treatments and/or procedures. * Conducts reviews to determine prior authorization /financial responsibility for Molina and its members. *… more
- Molina Healthcare (San Francisco, CA)
- …* At least 2 years experience, including experience in hospital acute care, inpatient review , prior authorization , managed care, or equivalent combination of ... stay for requested treatments and/or procedures. * Conducts reviews to determine prior authorization /financial responsibility for Molina and its members. *… more
- Molina Healthcare (Los Angeles, CA)
- …* At least 2 years experience, including experience in hospital acute care, inpatient review , prior authorization , managed care, or equivalent combination of ... stay for requested treatments and/or procedures. * Conducts reviews to determine prior authorization /financial responsibility for Molina and its members. *… more
- Molina Healthcare (Columbus, OH)
- …* At least 2 years experience, including experience in hospital acute care, inpatient review , prior authorization , managed care, or equivalent combination of ... stay for requested treatments and/or procedures. * Conducts reviews to determine prior authorization /financial responsibility for Molina and its members. *… more
- US Tech Solutions (May, OK)
- …inpatient hospital experience . Registered Nurse in state of residence . Must have prior authorization utilization experience . Able to work in multiple IT ... MANAGED CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review . ....knowledge of Milliman/MCG. . MUST HAVE 6 months of Prior Authorization . Education: . Active and unrestricted… more
- Molina Healthcare (Sparks, NV)
- …benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina ... + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. +...Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management… more
- Molina Healthcare (Ann Arbor, MI)
- …benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina ... + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. +...Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management… more
