- Centene Corporation (Jefferson City, MO)
- …between utilization management team, members, and providers + Monitors prior authorization , concurrent review, and/or retrospective clinical review nurses ... on workplace flexibility. **_ Remote Role _** **Position Purpose:** Supervises Prior Authorization , Concurrent Review, and/or Retrospective Review Clinical… more
- Humana (Madison, WI)
- …specifically Word, Excel, and Outlook. + At least 3-years experience with prior authorization / utilization management. **Preferred Qualifications** + ... and help us put health first** The UM/PA Nurse Supervisor plays a key leadership role in overseeing the...leadership role in overseeing the daily operations of the Utilization Management and Pre- Authorization nursing teams. This… more
- Actalent (Sunrise, FL)
- …direct utilization and capture data effectively. Responsibilities + Review prior authorization requests for medical necessity and appropriateness, utilizing ... a liaison between the Medical Director, physicians, and office staff, resolving prior authorization issues. + Communicate denial determinations to providers when… more
- 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 ... 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager...Knowledge, Skills & Abilities (must have):** + Experience with prior authorization and retrospective reviews + Proficiency… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …advocate between Dana Farber Cancer Institute and various health plans. Reporting to the Prior Authorization Supervisor , the Clinical Authorization ... be overturned. + Appropriately escalates complex cases to Drug Authorization Supervisor or Manager of Prior...year of clinical and/or related experience required. Case Management, Utilization Review and/or Prior Authorization … more
- Dignity Health (Rancho Cordova, CA)
- …and the appropriate application of policies and guidelines to Managed Care prior authorization referral requests. Under general supervision this position is ... Summary:** Under the guidance and supervision of the department Manager/Director the Supervisor of Utilization Management is responsible and accountable for… more
- AmeriHealth Caritas (LA)
- …clinical experience in home healthcare or a medical office setting. + Previous prior authorization experience is required.; + Proficiency in Electronic Medical ... about us at www.amerihealthcaritas.com. **Responsibilities:** Under the direction of a supervisor , the Clinical Care Reviewer - Utilization Management evaluates… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …you to apply! Job Description: Summary: This position supports the Utilization Management (UM) workflows by providing administrative support and customer service. ... Services. + Serves as the primary contact for providers regarding authorization requests. + Contacts members and providers concerning regulatory requirements… more
- ChenMed (North Miami Beach, FL)
- …rapidly expanding and we need great people to join our team. The Supervisor , Intensive Community Care, RN is a multi-market leadership position responsible for ... guidance to their team. Directly reporting to the Manager of ICC, this Supervisor is responsible for their teams members assigned patient case load whose role… more
- ASM Global (Houston, TX)
- …north dock at NRG Stadium and NRG Center. + Ensuring all shipments received have prior authorization and verifying with the tenant any shipmentswithout prior ... has an excellent and immediate opening for a Dock Supervisor at NRG Park in Houston, Texas. NRG Park...Standards, applicable local codes and NFL's Best Practices. + Utilization of a variety of technological software, platforms, and… more
- Molina Healthcare (Savannah, GA)
- …this family include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns ... and comply with CMS guidelines. These staff may also be involved in providing utilization management/ prior authorization services as needed. * Supervises the… more
- Mohawk Valley Health System (Utica, NY)
- …SNH is responsible for the oversight of the case management staff's authorization /coordination/ utilization and provision of member services. Duties include the ... RN Supervisor Case Management - Full Time - Days...direct oversight of the case manager's daily operations of utilization review practice, processes and procedures ensuring accurate member… more
- Air National Guard Units (Eielson AFB, AK)
- …the Alaska Air National Guard. PDCN: D14440000 MPCN: 3400860585 Selecting Supervisor : Megan L. Binkley Responsibilities Planning: Plans the overall allocation of ... economical and efficient work operations. Analyzes production, cost and personnel utilization records and makes adjustment in operations to correct problems.… more
- UNC Health Care (Durham, NC)
- …Maintains expertise in core pharmacy technician functions, including medication access, prior authorization , copay assistance, and use of relevant systems. ... program here: https://jobs.unchealthcare.org/pages/pharmacy-technician-commitment-incentive-program Summary: The Pharmacy Benefit MAP Technician Supervisor helps lead a team of technicians who provide… more
- Nobis Works (Atlanta, GA)
- Job Descriptions: Position Summary: The Supervisor , Youth Educational Services will oversee day-to-day operations of Tommy Nobis Centers Early Youth Employment ... at the highest level of quality, + Responsible for acquiring service authorization and maintaining adequate reporting records for each individual receiving services.… more
- Air National Guard Units (Birmingham, AL)
- …SERVICE POSITION. This National Guard position is for a AIRCRAFT MAINTENANCE SUPERVISOR (T32), Position Description Number D1444000 and is part of the AL 117TH ... economical and efficient work operations. Analyzes production, cost and personnel utilization records and makes adjustment in operations to correct problems.… more
- Air National Guard Units (Eielson AFB, AK)
- …Air National Guard. PDCN: D2180P01 / D2181P01 MPCN: 889707 Selecting Supervisor : James Meyer Responsibilities GS-09 - Administers classified and unclassified local ... and software and develops base wide network operating procedures. Analyzes LAN utilization statistics through data collection and performance measures to ensure the… more
- Veterans Affairs, Veterans Health Administration (Miami, FL)
- …follows a capabilities model to achieve goals for eligibility, referral and authorization , care coordination, and utilization management to ensure improved ... improving the Veteran's experience and outcomes. Defines mental health policies, utilization management process and procedures, financial and utilization reports… more
- Army National Guard Units (Lincoln, NE)
- …group grievances, or more serious unresolved complaints, to a higher-level supervisor . Approves expenses comparable to within-grade increases, employee travel, etc. ... to ensure systems and programs are functioning properly; effective utilization and maintenance of equipment; and that projects are...of the Nebraska National Air or Army National Guard prior to the effective date of hire. MILITARY REQUIREMENTS:… more
- Air National Guard Units (Reno, NV)
- …is to perform preliminary planning and long term forecasting of utilization of aerospace vehicles, engines, and associated support equipment. Responsibilities 1. ... for advising, planning and coordinating aircraft maintenance requirements and utilization scheduling between maintenance, operations, and external organizations. Actively… more
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