- Commonwealth Care Alliance (Boston, MA)
- …Skills & Abilities (must have):** + Experience with prior authorization and retrospective reviews + Proficiency reviewing clinical/ medical records and ... timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization...+ Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical… more
- NORTH RANGE BEHAVIORAL HEALTH (Greeley, CO)
- …ensure payment of services; align services with payor authorizations and/or request authorization prior to provision of service. Assume responsibility to follow ... - Greeley, CO Salary Range $68900.00 - $103240.00 Salary Description Registered Nurse Crisis Stabilization Services Acute Treatment Unit Shift: Friday and Saturday… more
- Luke Staffing (Yigo, GU)
- ** NURSE - REFERRAL MANAGEMENT** **SITE OF SERVICE:** +...+ Ensures Line of Duty paperwork is on file prior to authorization . + Verify eligibility of ... Base, Guam + Full Time **POSITION QUALIFICATION/REQUIREMENTS:** + **Education:** Vocational Nurse Program OR Baccalaureate of Science in Nursing Program from an… more
- Aveanna Healthcare (Cedar Rapids, IA)
- …O complete and document the client start of care Submit required documentation for prior authorization of client services as needed based on client's pay sources ... contribution to team shared on-call rotation. Position Overview The Admissions Registered Nurse (RN) works next to the Clinical Manager and/or Executive Director to… more
- Lucile Packard Children's Hospital (Palo Alto, CA)
- …specific authorization and supervision of a licensed physician or nurse . Administers medication following approved procedures and only after verification of ... the general nature, level and purpose of the job. Medical Assistant I is the entry, developmental and first...and collects medication information. * Prepares patient examination rooms prior to the visit to ensure that proper equipment… more
- PharmaCord (Lexington, KY)
- …and communicates patient's plan benefit coverage including the need for prior authorization , appeal, tier exception, and/or formulary exclusions. Serves ... support resources for patients. Proactively communicates needs for reverification of prior authorization or re-enrollment. Identifies and reports adverse events,… 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
- PharmaCord (Jeffersonville, IN)
- …Identifies and communicates patient's plan benefit coverage including the need for prior authorization , appeal, tier exception, and/or formulary exclusions Uses ... from the PharmaCord pharmacy Proactively communicates needs for reverification of prior authorization or re-enrollment for patient assistance program Reports… more
- Stony Brook University (Stony Brook, NY)
- …with nurse case manager/social worker team regarding payer delays, authorization and denial notification. + Serve as a liaison between hospital departments ... assist with transitional office operations. Individual works closely with Nurse Case Managers and Social Workers regarding payer delays,...+ Bachelor's degree + At least 3 years of prior experience working in an academic medical … more
- PharmaCord (Jeffersonville, IN)
- …necessary. Identify and communicate patients' plan benefit coverage, including any prior authorization , appeal, tier exception, or formulary exclusion ... the PharmaCord pharmacy. Proactively communicate the need for re-verification of prior authorization or re-enrollment for patient assistance programs. Report… more
- Genmab (Berkeley Heights, NJ)
- …not limited to Medicare, Medicaid and commercial insurance carriers, Prior Authorization submissions/appealsUnderstanding of the healthcare industry, including ... of insurance coverage including review of benefit verifications, research of prior authorizations and support through the appeals processEvaluate and refer patients… 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 ... of care from initial assess point. Follows cases for authorization for in patient stay. + Staff review short...required. **Qualifications** **Required** : A Bachelor's degree or a nurse working on their degree with an RN license… more
- GIBSON AREA HOSPITAL (Gibson City, IL)
- …chemistry testing, immunology testing, and microbiology testing as ordered. 16. Obtain prior authorization (s) for procedures and testing. 17. Follows Infection ... phone calls, documents patient message and forwards information to nurse , APN, PA, Physician. Does not provide medical... nurse , APN, PA, Physician. Does not provide medical advice or recommend treatment. 9. Sends patients reminders… more
- Moses/Weitzman Health System (Bethel, CT)
- …by laws in a timely manner, included by not limited to intake, prior authorization request, progress notes, treatment plan documentation, and discharge. + ... is one of the country's most creative and dynamic providers of primary medical , dental, and behavioral health services, and a leader in practice-based research,… more
- Cordis (Irvine, CA)
- …by creating next-generation solutions that address unmet and critical medical needs. **Responsibilities** The **Field Specialist, Clinical Research** position that ... clinical research in this same role or as a nurse or tech as radiology tech or Cath lab...experience working directly with physicians and healthcare professionals + Prior experience with clinical trials (preferred) + Experience in… more
- Centene Corporation (New York, NY)
- …**Must have a New York State nursing license.** **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service ... medical necessity of care of member + Escalates prior authorization requests to Medical ...management processes preferred. **License/Certification:** + LPN - Licensed Practical Nurse - State Licensure required + RN - Registered… 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
- UCLA Health (Los Angeles, CA)
- …clinical documentation related to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards, ... Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role in ensuring the delivery...of resources. Key Responsibilities: + Conducts clinical reviews of prior authorization requests to evaluate medical… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Pre- Authorization Nurse 2 reviews prior authorization requests for appropriate ... services or forward requests to the appropriate stakeholder. The Pre- Authorization Nurse 2 work assignments are varied...to Tier III care management as needed. * Perform prior authorization reviews according to established HUMANA… more
- Select Medical (Knoxville, TN)
- …**Select Specialty Hospital - North Knoxville** Critical Illness Recovery Hospitals ** Prior Authorization Specialist/ Payor Relations Specialist** **(RN or LPN ... right. As the Payor Relations Specialist, you will manage the pre-certification and prior authorization of referrals scheduled for admission to our hospital.… more
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