- Humana (Columbus, OH)
- …care industry + Previous Medicare/Medicaid experience a plus. + Previous experience in prior authorization , utilization management + Experience working ... that supports the goal to put health first? The Prior Authorization , Registered Nurse, RN, Intern will...review depending on case findings. + Educates providers on utilization and medical management processes. + Enters… more
- Humana (Louisville, KY)
- … utilization management staff; direct performance regarding prior authorization , medical necessity determinations, concurrent review, retrospective ... the SIU Team to assure that service guidance to utilization management staff, prior authorization team members ensuring that the service provided meets… more
- Centene Corporation (Olympia, WA)
- …to member care, provider interactions, and facilitates operations within utilization management . + Manages prior authorization , concurrent review, and ... supervisory experience preferred. + Knowledge of utilization management principles preferred. + Prior Authorization... utilization management principles preferred. + Prior Authorization highly preferred + Medicaid experience… more
- Centene Corporation (Jefferson City, MO)
- …**Position Purpose:** Oversee operations of the referral management , telephonic utilization review, prior authorization , and various related functions ... Committee for Quality Assurance (NCQA) standards for utilization management functions, prior authorization and concurrent review units + Collaborate with… more
- Elevance Health (San Antonio, TX)
- …personalized support throughout the consumer's treatment journey. **Title:** Utilization Management Representative II - Prior Authorization **Location:** ... Possibilities. Make an extraordinary impact.** The Utilization Management Representative II - Prior Authorization... Utilization Management Representative II - Prior Authorization is responsible for managing incoming… more
- Sanford Health (SD)
- …team regarding trends, external regulations and internal policies that effect resource utilization and potentially, prior authorization . Assists the ... Conduct level of care medical necessity reviews within patient's medical records. Performs utilization management (UM) activities in accordance with UM plan to… more
- Sanford Health (WI)
- …**Weekly Hours:** 40.00 **Salary Range:** $21.50 - $28.00 **Job Summary** Monitors the utilization of resources, risk management and quality of care for patients ... Collection of clinical information necessary to initiate commercial payor authorization . Obtain and maintain appropriate documentation concerning services in… more
- Prime Therapeutics (Columbus, OH)
- …of Utilization Management requests (ie formulary exceptions, prior authorization , step therapy, quantity limit exceptions) for delegated products ... evaluation for coverage determination requests for prior authorization (PA) or other utilization management... prior authorization (PA) or other utilization management (UM) programs, including quantity limits,… more
- US Tech Solutions (LA)
- …walls of a hospital setting in a specialty area of the nursing field providing utilization management prior authorization reviews. Build strong direct ... Minimum 3 years nursing experience with a minimum of 1 year in utilization management / prior authorization review experience. **Experience** : … more
- Actalent (San Antonio, TX)
- …successful completion of cases. Essential Skills + Experience in utilization management , concurrent review, prior authorization , utilization review, ... planning. + Proficiency with InterQual. + Active TX RN License. + Utilization Management /Concurrent Review experience. + ICU/ER experience. + Strong… more
- Centene Corporation (Sacramento, CA)
- …shift Pacific Standard Hours with rotating weekends.** **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
- Kelsey-Seybold Clinic (Pearland, TX)
- …ICD 10 Coding methodologies. Prior experience with precertification and/or utilization management **License(s)** Required: N/A Preferred: Epic System usage ... **Responsibilities** Under the supervision of the Business Services Supervisor, the Prior Authorization Specialist (PAS) is responsible for processing incoming… more
- UCLA Health (Los Angeles, CA)
- Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role in ensuring the delivery of high-quality, evidence-based care. This ... responsible for reviewing and evaluating clinical documentation related to prior authorization requests for medical services. The...+ A minimum of three years of experience in utilization management , preferred + Team leading or… more
- Molina Healthcare (Columbus, OH)
- …standing Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
- Molina Healthcare (Las Cruces, NM)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… 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
- State of Georgia (Thomas County, GA)
- New Options Waiver/Comprehensive Supports Waiver Prior Authorization Billing Specialist- Thomasville Georgia - Thomas - Thomasville ... Job Alerts Job Description Job Title: New Options Waiver/Comprehensive Supports Waiver Prior Authorization Billing Specialist- Thomasville Pay Grade: J Job… more
- Intermountain Health (Murray, UT)
- …and operational management of utilization review programs to include prior authorization , acute and post acute concurrent review for various service ... lines of business(s). The position requires an understanding of utilization management industry benchmarks, best practices and regulatory environment for the… more
- Ascension Health (Nashville, TN)
- …inpatientutilization management programs. + Oversee implementation and maintenance of prior authorization codes for all clients. **Requirements** Licensure / ... **Details** + **Department:** Utilization Management + **Schedule:** Monday -...Nurse credentialed from the Tennessee Board of Nursing obtained prior to hire date or job transfer date required.… more
- Humana (Frankfort, KY)
- …for turnaround times on authorization requests and delivery of Utilization Management services. + Support provider inquiry regarding Utilization ... community and help us put health first** The Manager, Behavioral Health Utilization Management uses clinical knowledge, communication skills, and independent… more
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