- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Role BHPS provides Utilization Management services to its clients. The Utilization Management Nurse - Prior Authorization performs medical necessity reviews ... on prior authorization requests in accordance with national standards, contractual requirements,...surgical cases preferred. Essential Qualifications * Current licensed Registered Nurse (RN) or Licensed Practical Nurse (LPN)… more
- US Tech Solutions (May, OK)
- …other clinical colleagues, healthcare professionals and members. + * Follow all prior authorization procedures to guarantee an accurate process on each ... policy and procedure. + * Provide on-call after hours nurse availability for urgent PA requests. + * Provide... prior authorization . + * Train and mentor... prior authorization . + * Train and mentor representatives on the… more
- Centene Corporation (Sacramento, CA)
- …Standard Hours with occasional weekends and holidays.** **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service ... interdepartmental teams, to assess medical necessity of care of member + Escalates prior authorization requests to Medical Directors as appropriate to determine… more
- US Tech Solutions (May, OK)
- …pharmacists, other clinical colleagues, healthcare professionals and members. + Follow all prior authorization procedures to guarantee an accurate process on ... following policy and procedure. + Provide on-call after hours nurse availability for urgent PA requests. + Provide internal...each prior authorization . + Train and mentor representatives… more
- US Tech Solutions (LA)
- **Position Summary:** As a Prior Authorization Nurse , you work outside the walls of a hospital setting in a specialty area of the nursing field providing ... utilization management prior authorization reviews. Build strong direct relationships...indicated by staffing and business needs. **Duties:** + **Registered Nurse with current license in LA state of employment.… more
- Humana (Madison, WI)
- **Become a part of our caring community and help us put health first** The Pre- Authorization Nurse 2 reviews prior authorization requests for appropriate ... and approves services or forward requests to the appropriate stakeholder. The Pre- Authorization Nurse 2 work assignments are varied and frequently require… more
- Humana (Atlanta, GA)
- …barriers to helping people achieve their best health. Humana CarePlus is seeking a Pre- Authorization Nurse who reviews prior authorization requests for ... and approves services or forward requests to the appropriate stakeholder. The Pre- Authorization Nurse roles and responsibilities include but are not limited… more
- Staffing Solutions Organization (Augusta, ME)
- …PA reviews/dispositions based on business rules and workflow policies; + Work with the Prior Authorization unit staff members to monitor work queues and complete ... of our clients and the people they serve. **Registered Nurse - Authorization Review Unit - MaineCare...MaineCare in Augusta, ME** **Position Duties:** + Manage medical Prior Authorizations (PA) as assigned by the PA supervisor,… more
- Humana (Madison, WI)
- …specifically Word, Excel, and Outlook. + At least 3-years experience with prior authorization / utilization management. **Preferred Qualifications** + Bachelor of ... a part of our caring community and help us put health first** The UM/PA Nurse Supervisor plays a key leadership role in overseeing the daily operations of the… more
- Elevance Health (San Antonio, TX)
- …the consumer's treatment journey. **Title:** Utilization Management Representative II - Prior Authorization **Location:** TX-SAN ANTONIO, 4751 HAMILTON WOLF RD, ... Make an extraordinary impact.** The **Utilization Management Representative II - Prior Authorization ** is responsible for managing incoming calls, including… more
- Select Medical (Columbus, OH)
- …Recovery Hospital & Acute Inpatient Rehabilitation Hospitals **Payor Relations Specialist / Prior Authorization Specialist** **( RN , LPN )** **This position ... Payor Relations Specialist, you will manage the pre-certification and prior authorization of referrals scheduled for admission...in third party reimbursement. + Must be a Registered Nurse (RN) or Licensed Practical Nurse (LPN).… more
- Molina Healthcare (Albuquerque, NM)
- …Utilization Review RN or LPN in New Mexico. This team reviews the prior authorization requests for our New Mexico Medicaid recipients. Preference will ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
- Select Medical (Frisco, TX)
- …A joint venture with Select Medical & Baylor Scott & White Health Frisco, TX ** Prior Authorization Specialist / Payor Relations Specialist ( RN , LPN )** ... and independent judgment, the Payor Relations Specialist manages the pre-certification and prior authorization of referrals scheduled for admission to the Acute… more
- LifePoint Health (Wilson, NC)
- …opportunities * * *Department/Unit Summary The LPN Testing, Scheduler, and Prior Authorization Coordinator is responsible for coordinating patient testing, ... *Licensed Practical Nurse (LPN), Pulmonary Clinic* Job Type: Full-Time, Days...setting, Gastro experience preferred . Knowledge of insurance policies, prior authorization procedures, and medical terminology. .… more
- Molina Healthcare (Spokane, WA)
- …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. +...Any of the following: Completion of an accredited Registered Nurse (RN), Licensed Vocational Nurse (LVN) or… more
- CVS Health (Lansing, MI)
- …level **Required Qualifications** + Candidate must have active, current and unrestricted Registered Nurse (RN) Licensure in state of residence + Must be able to work ... department + 3+ years clinical experience as a Registered Nurse + 3+ years of managed care experience +...+ Candidate must have active, current and unrestricted Registered Nurse (RN) Licensure in state of residence **Anticipated Weekly… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve as a liaison and ... between Dana Farber Cancer Institute and various health plans. Reporting to the Prior Authorization Supervisor , the Clinical Authorization Specialist is… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …Specialist is responsible for the comprehensive coordination and management of all prior authorization activities specific to cellular therapy services. This ... experience required. + Case Management, Utilization Review, Oncology, Cellular Therapy and/or Prior Authorization experience is preferred. + Licensed as a… more
- Baptist Memorial (Memphis, TN)
- …strategy. Specifically the managed care techniques the Coordinator uses focuses on prior authorization for services using evidence based criteria. Areas of ... Overview Coordinator- Authorization Job Code: 22772 FLSA Status Job Family:...payer with patient access + Communicate with Utilization Review Nurse + Works assigned queues in the electronic medical… more
- US Tech Solutions (GA)
- …from distractions. You will provide processing and communication of specialty medication prior authorization (PA) requests reviewed by the Specialty Medical ... Prior Authorization department. Reporting to the Pharmacy Operations Manager, you...following policy and procedure. + Provide on-call after hours nurse availability for urgent PA requests. + Provide internal… more
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