- 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
- Premera Blue Cross (Mountlake Terrace, WA)
- …Coordinator** - **Clinical Appeals** performs prospective review (benefit advisory/ prior authorization ) admission, concurrent, and retrospective reviews ... necessity review that includes inpatient review, concurrent review, benefit advisory/ prior authorization , retrospective, out of network, and appropriateness… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …necessity review that includes inpatient review, concurrent review, benefits advisory/ prior authorization , retrospective, out of network, and appropriateness ... or four (4) years' work experience **(Required)** + Current State Licensure as a registered nurse where licensing is required by State law **(Required)** + Three… 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
- 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… more
- Guthrie (Corning, NY)
- …and timely dispensing of the medication for the patient as needed. Medication Prior Authorization Collect necessary documentation and submit it to the patient's ... needed for patient that have arrived without orders. Prepare educational materials for the RN Nurse Navigator for Chemo Education Visits per the instruction and… 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 Review RN to fill an opening with a Prestigious HealthCare Company in Remote Houston… more
- Tidelands Health (Georgetown, SC)
- …communication skills and ability to multi-task required. **Licenses and Certifications** + Registered Nurse - South Carolina Department of Labor, Licensing and ... Team Tidelands and help people live better lives through better health!** **Outpatient Nurse ( RN )** Are you passionate about quality and committed to excellence?… more
- National Youth Advocate Program (Madison, WI)
- …or Vocational Nurse (LPN/LVN) or higher health-related qualification (eg, Licensed Registered Nurse ( RN ) with a bachelor's degree) OR Bachelor's ... scheduling initial, follow-up, wellness, and specialist appointments; preparing Treatment Authorization Requests (TARs) prior to appointments and following… more
- National Youth Advocate Program (Fairfax, VA)
- …auditing processes. + Performs other duties as requested. **MINIMUM QUALIFICATIONS** + Licensed Registered Nurse ( RN ) with a Bachelor's or Higher ... + Assist in obtaining medical clearances from healthcare providers. + Preparing Treatment Authorization Requests (TARs) prior to appointments and following up to… 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
- Select Medical (West Orange, NJ)
- …- West Orange** A Select Medical Hospital West Orange, NJ ** Prior Authorization Specialist/ Payor Relations Specialist ( RN , LPN )** **Full-Time** **Onsite ... and independent judgment, the Payor Relations Specialist manages the pre-certification and prior authorization of referrals scheduled for admission to the Acute… 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 ... initial, concurrent and retrospective chart reviews for clinical utilization and authorization . The Utilization Review Case Manager coordinates with the healthcare… more
- Molina Healthcare (Dallas, TX)
- …TX licensed RN with Utilization Management experience to join our Prior Authorization reviewing team. Previous UM experience with MCG/Interqual guidelines as ... , managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted… 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
- Molina Healthcare (MS)
- …**JOB QUALIFICATIONS** **Required Education** Any of the following: Completion of an accredited Registered Nurse ( RN ), Licensed Vocational Nurse (LVN) ... medical clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ), Licensed Vocational Nurse … more
- CVS Health (Oklahoma City, OK)
- …current and unrestricted Oklahoma RN licensure **Preferred Qualifications:** + Prior Authorization Experience + Utilization Management Experience + Managed ... communication in a fast-paced environment. **Required Qualifications:** + 3+ years of clinical experience as a Registered Nurse in Med-Surg + Must have active,… more
- CVS Health (Phoenix, AZ)
- …them at the employee level. **Required Qualifications** + 5+ years of experience as a Registered Nurse ( RN ). + 2+ years of experience in utilization ... day. **Position Summary** The **Associate Manager, Clinical Health Services ( Prior Authorization )** is responsible for oversight of...supervisory capacity. + 7+ years of experience as a Registered Nurse ( RN ). + 5+… more
- Ascension Health (Indianapolis, IN)
- **Details** + **Department:** Prior Authorization + **Schedule:** Monday - Friday 8am - 4:30pm or 8:30am - 5pm (either schedule available), would also be open to ... + Assist with treatments ordered by provider as supervised by provider or registered nurse . Perform select clinical duties. + Interview patients, measure vital… 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
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