- Molina Healthcare (Seattle, 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
- UCLA Health (Los Angeles, CA)
- …This position is responsible for reviewing and evaluating clinical documentation related to prior authorization requests for medical services. The UM Review ... efficient utilization of resources. Key Responsibilities: + Conducts clinical reviews of prior authorization requests to evaluate medical necessity and benefit… 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
- South Central Regional Medical Center (Laurel, MS)
- …Prior Authorization Reports to: Department Manager Created: 5/1/25 Job Summary The Prior Authorization Nurse is responsible for managing the prior ... (RN) or Licensed Practical Nurse (LPN) license. + Experience in prior authorization , case management, or utilization review preferably in an ambulatory… 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
- Centene Corporation (New York, NY)
- …Applicants must possess NY RN State Licensure **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service and ... 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 (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
- Elevance Health (San Antonio, TX)
- …the consumer's treatment journey. **Title:** Utilization Management Representative II - Prior Authorization **Location:** 4751 Hamilton Wolf Rd, STE 101, ... Make an extraordinary impact.** The Utilization Management Representative II - Prior Authorization is responsible for managing incoming calls, including… more
- Molina Healthcare (Long Beach, CA)
- …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
- Sanford Health (SD)
- …relating to the implementation, ongoing evaluation, and improvements to UM and/or prior authorization processes with applicable. Completes activities relating to ... regulations and internal policies that effect resource utilization and potentially, prior authorization . Assists the department in monitoring the utilization… more
- Ascension Health (Wichita, KS)
- **Details** + **Department: Prior Authorization Radiology/Radiation Oncology** + **Schedule: M-F 8am-5pm** + **Clinic: Ascension Medical Group** + **Location: ... or experience, if applicable. **Additional Preferences** + Physician clinic with prior authorization experience preferred. **Why Join Our Team** Ascension… more
- Sanford Health (WI)
- …Collection of clinical information necessary to initiate commercial payor authorization . Obtain and maintain appropriate documentation concerning services in ... technology applications to insurance companies and contracted vendors to assure authorization for patients. May participate in providing assistance in financial aid… more
- Albany Medical Center (Albany, NY)
- …the Pre-Service functions of the Patient Engagement Center Insurance, Authorization and Scheduling complement- related to eligibility verification, pre-registration, ... authorization , financial clearance and scheduling needs of Hospital Services...in a timely manner, assuring a secured financial source prior to scheduling + Ensure staff and leadership maintain… 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
- 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 Summary The Authorization Coordinator is responsible for facilitating information documentation...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
- Louisiana Department of State Civil Service (St. Gabriel, LA)
- PRACTICAL NURSE -LICENSED 1, 2, OR 3 Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4776460) Apply PRACTICAL NURSE -LICENSED 1, 2, OR 3 ... has a Special Entrance Rate at each level Practical Nurse -Licensed 1 has an SER of $19.48 per hour....employee may be required to serve a trial detail prior to being permanently promoted. + TEMPORARY JOB APPOINTMENT:… more
- Louisiana Department of State Civil Service (Angola, LA)
- REGISTERED NURSE 1, 2, OR 3 Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4778866) Apply REGISTERED NURSE 1, 2, OR 3 Salary Depends on ... employee may be required to serve a trial detail prior to being permanently promoted + TEMPORARY JOB APPOINTMENT:...has a Special Entrance Rate at each level Registered Nurse 1 has an SER of $29.84 per hour.… more
- Louisiana Department of State Civil Service (St. Gabriel, LA)
- REGISTERED NURSE 1, 2, OR 3 Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4776430) Apply REGISTERED NURSE 1, 2, OR 3 Salary Depends on ... has a Special Entrance Rate at each level Registered Nurse 1 has an SER of $29.84 per hour....employee may be required to serve a trial detail prior to being permanently promoted. + TEMPORARY JOB APPOINTMENT:… more
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- REGISTERED NURSE --MANAGER Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4924551) Apply REGISTERED NURSE --MANAGER Salary $7,763.60 - ... employee may be required to serve a trial detail prior to being permanently promoted. This position has a...promoted. This position has a Special Entrance Rate. Registered Nurse Manager has an SER of $44.79 per hour.… more
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