- Elevance Health (San Antonio, TX)
- …the consumer's treatment journey. **Title:** Utilization Management Representative II - Prior Authorization **Location:** 4751 Hamilton Wolf Rd, STE 101, San ... impact.** The Utilization Management Representative II - Prior Authorization is responsible for managing incoming...caller. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. +… more
- Sanford Health (SD)
- …team regarding trends, external regulations and internal policies that effect resource utilization and potentially, prior authorization . Assists the ... relating to the implementation, ongoing evaluation, and improvements to UM and/or prior authorization processes with applicable. Completes activities relating to… more
- Sanford Health (ND)
- …- $28.00 **Department Details** Opportunity to work remote **Job Summary** Monitors the utilization of resources, risk management and quality of care for patients in ... Collection of clinical information necessary to initiate commercial payor authorization . Obtain and maintain appropriate documentation concerning services in… more
- Molina Healthcare (Columbus, OH)
- …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… 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
- 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 ... Description At UCLA Health, the Utilization Management (UM) Review Nurse plays...of resources. Key Responsibilities: + Conducts clinical reviews of prior authorization requests to evaluate medical necessity… more
- The Arora Group (Bethesda, MD)
- Licensed Practical Nurse (LPN) - Utilization Review Nurse Currently recruiting a Licensed Practical Nurse (LPN/LVN) - Utilization Review in Bethesda, ... Services will be required on Federal holidays. DUTIES OF THE LICENSED PRACTICAL NURSE (LPN/LVN) - UTILIZATION REVIEW: + Initiate, perform and complete assigned… more
- AdventHealth (Orlando, FL)
- …ROLLINS STREET, Orlando, 32803 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise ... including concurrent payer communications to resolve status disputes. The Utilization Management Nurse is accountable for a...payor authorization processes as required, ensuring proper authorization has been secured prior to or… 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 ... + Do you have experience with Prior Authorization ? + Do you have experience with Utilization... Review? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech Solutions… more
- CDPHP (Albany, NY)
- …responsible for the clinical review and documentation for services requiring prior authorization . This includes approval determinations and appropriate ... of acute care experience is required as a Registered Nurse . + Minimum of two (2) years Utilization... Nurse . + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of coding/claims… more
- US Tech Solutions (May, OK)
- …hospital experience . Registered Nurse in state of residence . Must have prior authorization utilization experience . Able to work in multiple IT ... and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review. . MUST HAVE 1 YEAR OF...knowledge of Milliman/MCG. . MUST HAVE 6 months of Prior Authorization . Education: . Active and unrestricted… more
- CVS Health (Jackson, MS)
- …of residence. + 3+ years of Nursing experience. Preferred Qualifications + Prior authorization utilization management/review experience preferred Outpatient ... and external constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications + Registered Nurse in… more
- CVS Health (Trenton, NJ)
- …Suite applications (Teams, Outlook, Word, Excel, etc.) **Preferred Qualifications** + Previous prior authorization experience + Prior experience working for ... Eastern Standard Time schedule** **Must be a licensed Registered Nurse , any compact licensure must cover New Jersey** +..., any compact licensure must cover New Jersey** + Utilization Management is a 24/7 operation and the work… 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. +...Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization… more
- AdventHealth (Altamonte Springs, FL)
- …**Job Location** : Remote **The role you will contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by ... including concurrent payer communications to resolve status disputes. The Utilization Management Nurse is accountable for a...payor authorization processes as required, ensuring proper authorization has been secured prior to or… more
- Ascension Health (Nashville, TN)
- …and inpatientutilization management programs. + Oversee implementation and maintenance of prior authorization codes for all clients. **Requirements** Licensure / ... **Details** + **Department:** Utilization Management + **Schedule:** Monday - Friday. 40...Certification / Registration: + Registered Nurse credentialed from the Tennessee Board… more
- Centene Corporation (San Antonio, TX)
- …services to ensure level of care and services are medically appropriate + Performs prior authorization reviews related to mental health and substance abuse to ... if you hold a LPC, LCSW, or LMFT. Registered Nurse can hold Texas State Licensure and/or Compact State...Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members… more
- Elevance Health (Winston Salem, NC)
- … Management Representative I** is responsible for coordinating cases for precertification and prior authorization review. **How will you make an impact:** + ... ** Utilization Management Representative I** **Location:** Within 50 miles...provides authorization for inpatient admission, outpatient precertification, prior authorization , and post service requests. +… more
- Centene Corporation (Tallahassee, FL)
- …services to ensure level of care and services are medically appropriate + Performs prior authorization reviews related to mental health and substance abuse to ... Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… 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:...Communicates incorrect payer with patient access + Communicate with Utilization Review Nurse + Works assigned queues… more
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