- 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 ... **Required Knowledge, Skills & Abilities (must have):** + Experience with prior authorization and retrospective reviews + Proficiency reviewing clinical/medical… more
- Stony Brook University (Stony Brook, NY)
- …with the transferring hospital, Patient Access and physicians and payers for authorization prior to transfer from other hospitals. + Consistent documentation ... RN Case Manager **Position Summary** At...required. **Qualifications** **Required** : A Bachelor's degree or a nurse working on their degree with an RN… more
- 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 Utilization...Communicates concerns that arise in these discussions to the Manager and/or Medical Director. 4. Maintains knowledge of the… more
- Commonwealth Care Alliance (Boston, MA)
- …Director of Utilization Management - Oversees clinical decision review for services requiring prior authorization in a variety of clinical areas, including but ... (must have): - Expertise in managing utilization review processes including prior authorization , concurrent and retrospective reviews - Demonstrated ability… more
- Lucile Packard Children's Hospital (Palo Alto, CA)
- …of abuse/neglect activity, and mobility. * Performs the following procedures as directed by Registered Nurse ( RN )/ Nurse Practitioner (NP)/ Physician (MD) ... specific authorization and supervision of a licensed physician or nurse . Administers medication following approved procedures and only after verification of… more
- CVS Health (Phoenix, AZ)
- …do it all with heart, each and every day. **Position Summary** The **Associate Manager , Clinical Health Services ( Prior Authorization )** is responsible for ... **Required Qualifications** + 5+ years of experience as a Registered Nurse ( RN ). + 2+...comfortable working weekends and evening hours. **Preferred Qualifications** + Prior experience in a supervisory capacity. + 7+ years… more
- University of Miami (Miami, FL)
- …CORE FUNCTIONS: + Adhere and perform timely prospective review for services requiring prior authorization as well as timely concurrent review for continuation of ... conducts initial, concurrent and retrospective chart reviews for clinical utilization and authorization . The Utilization Review Case Manager coordinates with the… more
- AdventHealth (Glendale Heights, IL)
- …management and resolution skills + Teamwork principles + Registered Nurse ( RN ) Required + Certified Case Manager (CCM) Preferred + Accredited Case ... prior to the discharge of the patient. The RN Care Manager is responsible for optimal...standard work. + Communicates with Payors patients needs for authorization for post-acute care as needed. + Assesses patients… more
- Tenet Healthcare (Detroit, MI)
- Registered Nurse ( RN ) - Case Manager - 2506003285 Description : Join our dedicated healthcare team where compassion meets innovation! As a Registered ... and is determined by employment status Job Description: The RN Case Manager is responsible to facilitate...management experience preferred. 3. License to practice as a Registered Nurse in the State of Michigan.… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse ( RN ) Manager , Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances Location: ... + Excellent verbal, written communication and presentation skills. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and… more
- Louisiana Department of State Civil Service (Kinder, LA)
- REGISTERED NURSE 1, 2, OR 3 Print...employee may be required to serve a trial detail prior to being permanently promoted + TEMPORARY JOB APPOINTMENT: This ... (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4780542) Apply REGISTERED NURSE 1, 2, OR 3 Salary...license, or DD-214 must be verified by official documentation prior to hire. + Any qualifying experience that is… more
- Louisiana Department of State Civil Service (St. Gabriel, LA)
- REGISTERED NURSE 1, 2, OR 3 Print...employee may be required to serve a trial detail prior to being permanently promoted. + TEMPORARY JOB APPOINTMENT: This ... (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4776430) Apply REGISTERED NURSE 1, 2, OR 3 Salary Depends on Qualifications Location St.… more
- Louisiana Department of State Civil Service (Angie, LA)
- REGISTERED NURSE 1, 2 or 3 (WAE)...license, or DD-214 must be verified by official documentation prior to hire. + Any qualifying experience that is based ... Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4777670) Apply REGISTERED NURSE 1, 2 or 3 (WAE) Salary $4,177.00 - $7,518.00 Monthly… more
- Project Renewal, Inc. (New York, NY)
- Title: Nurse Care Manager for Drug User...the buprenorphine census) Qualifications: + Active New York State Registered Nurse ( RN ) license + ... C infection. Position Overview: Project Renewal is seeking a Nurse Care Manager (NCM) for Drug User...to track prescribing and pharmacy fill history + Insurance authorization and troubleshooting coverage issues + Relationship building and… more
- North Shore Community Health (Peabody, MA)
- …opening for a Registered Nurse . Under the general direction of the Clinical Nurse Manager , the Registered Nurse will provide direct and indirect ... Registered Nurse Peabody, MA (http://maps.google.com/maps?q=89+Foster+Street+Peabody+MA+USA+01960) Description...when needed within the scope of nursing practice, including prior authorization forms . Provides health education… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …coverage denials cannot be overturned. + Appropriately escalates complex cases to Drug Authorization Supervisor or Manager of Prior Authorizations. + ... environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve as a liaison and… more
- Veterans Affairs, Veterans Health Administration (Albuquerque, NM)
- … Nurse Case Managers to join our team! Responsibilities The Community Care Case Manager is a Registered Nurse , qualified by education and experience. The ... and expertise for the coordination of NMVAHCS non-VA care authorization program. Demonstrate knowledge of Fee federal regulations, VHA...have opportunity to become registered as a nurse with a state licensing board prior … more
- US Tech Solutions (Columbia, SC)
- …the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC) **About US Tech ... + Skill sets: Appeals and reconsideration experience, Utilization management experience, Prior experience working for a health insurance company and/or with Medicare… more
- Trinity Health (Albany, NY)
- …ass needed **What you will need:** **Required:** + A current license to practice as a Registered Nurse ( RN ) in the State of New York + Associate's degree ... **Employment Type:** Full time **Shift:** Day Shift **Description:** ** RN Care Manager (Long Term Care...well as insurance companies to manage insurance verifications and prior authorizations + Continual review and authorization … more
- Beth Israel Lahey Health (Plymouth, MA)
- …the job that may reasonably be required._ **Education/Experience Required:** _Required_ + State of MA Registered Nurse ( RN ) + 3-5 years acute care nursing + ... summer and one winter holiday. **Job Description:** The Emergency Department Case Manager is responsible and accountable for patient trajectory by assisting the… more
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