- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- … Utilization Management services to its clients. The Utilization Management Nurse - Prior Authorization performs medical necessity reviews on ... prior authorization requests in accordance with national standards, contractual requirements,...coverage while working remotely. Primary Responsibilities * Perform prospective utilization reviews and first level determinations for members using… more
- Elevance Health (Woodbridge, NJ)
- …assess provider satisfaction. Assessment shall include provider experiences with claims processing, prior authorization , utilization management , and ... **Clinical Quality Management Analyst Sr. Behavioral Health** **Location:** 111 Wood...(HCQM) by the American Board of Quality Assurance and Utilization Review Physicians. **Preferred Skills, Capabilities & Experiences:** +… more
- Centene Corporation (Olympia, WA)
- …health programs such as mental health parity, community services overutilization, prior authorization , and utilization management reform. + Serve as the ... as mental health parity, community services overutilization, prior authorization , and utilization management reform. + Analyze data related to behavioral… more
- Centene Corporation (Olympia, WA)
- …health programs such as mental health parity, community services overutilization, prior authorization , and utilization management reform. + Serve as the ... as mental health parity, community services overutilization, prior authorization , and utilization management reform. + Analyze data related to behavioral… 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
- 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 (Dallas, TX)
- …successful completion of cases. Essential Skills + Experience in utilization management , concurrent review, prior authorization , utilization review, ... planning. + Proficiency with InterQual. + Active Compact RN License. + Utilization Management /Concurrent Review experience. + ICU/ER experience. + Strong… more
- Highmark Health (Buffalo, NY)
- …to fulfill the call, such as verifying benefit coverage, creation of a prior authorization case in Highmark's Utilization Management system for Prior ... **ONLY This job captures all inbound phone inquires for utilization management review from providers and pharmacies....phone requests from providers or pharmacy for all inbound Prior Authorization requests.Use multiple software systems and… more
- Kelly Services (Greece, NY)
- **Kelly(R) is looking for a Pharmacy Prior Authorization Technician to work at a top insurance client in the vibrant Rochester, NY area. Let us help you grow at ... **Hours:** M-F 8am to 5pm **Summary Description:** The Pharmacy Prior Authorization Technician is responsible for the...policies and procedures to prepare and interpret cases for utilization management reviews. As a content expert,… more
- Commonwealth Care Alliance (Boston, MA)
- …CCA-Auth & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Utilization Management ( Authorization ) Unit is primarily responsible for ... under the provisions of CCA's benefits plan. The Manager, Utilization Management is responsible for overseeing and...Skills & Abilities (must have): * Expertise in managing utilization review processes including prior authorization… more
- Centene Corporation (Atlanta, GA)
- …including a fresh perspective on workplace flexibility. **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
- Actalent (Sunrise, FL)
- Actalent is hiring a Utilization Management Nurse! Job Description The Utilization Management Nurse (UMN) collaborates closely with the interdisciplinary ... safety, and appropriate length of stay. Responsibilities + Review prior authorization requests for medical necessity and...activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management … more
- Centene Corporation (Jefferson City, MO)
- …on key initiatives and to facilitate on-going communication between utilization management team, members, and providers + Monitors prior authorization , ... on workplace flexibility. **_ Remote Role _** **Position Purpose:** Supervises Prior Authorization , Concurrent Review, and/or Retrospective Review Clinical… more
- Molina Healthcare (Albuquerque, NM)
- …experienced Utilization Review LPN in New Mexico. This team reviews the prior authorization requests for our New Mexico Medicaid recipients. Preference will ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
- Molina Healthcare (Spokane, WA)
- …are seeking a candidate with a WA state LPN licensure. Candidates with case management , Utilization Management (UM), and direct managed care experience are ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) ... review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role...+ Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical… more
- AdventHealth (Glendale Heights, IL)
- …AVE, Glendale Heights, IL 60139 **The role you'll 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
- Molina Healthcare (San Antonio, TX)
- …include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... and effectively. These pharmacists may also be involved in providing utilization management / prior authorization services. Key duties include any… more
- University of Rochester (Rochester, NY)
- …such as Medicaid Enrollment & Outreach, Financial Assistance, Registration and Insurance Management , Utilization Management , Social Work, Patient Accounts, ... Medical Records, Home Care Coordinators, Prior Authorization Teams, Contracting and Finance. +...experience REQUIRED. **KNOWLEDGE, SKILLS & ABILITIES** + Experience in management , operations, and leadership PREFERRED. + Requires a high… more
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