- 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 (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
- CVS Health (Phoenix, AZ)
- …**Position Summary** You will provide processing and communication of specialty medication prior authorization (PA) requests reviewed by the Aetna Specialty ... Medical Prior Authorization department. Reporting to the Pharmacy...necessary and will involve computer system data entry, data management , and reporting. + Review criteria-based prior … 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
- Dana-Farber Cancer Institute (Brookline, MA)
- …+ 1 year of clinical and/or related experience required. Case Management , Utilization Review and/or Prior Authorization experience is preferred. + ... Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve as a liaison and patient advocate… 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
- 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
- CVS Health (Carson City, NV)
- …of relevant experience in Nursing. + At least 1 year of Utilization Management experience in concurrent review or prior authorization . + Strong ... high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join...+ Experience in a high-volume clinical call center or prior remote work environment. **Education** + Associate's degree in… more
- CVS Health (Austin, TX)
- …Office applications (Outlook, Teams, Excel) **Preferred Qualifications** + Prior authorization or Utilization Management experience + Managed care ... internal and external constituents in the coordination and administration of the utilization /benefit management function. **_Please note: This is a full time… more
- Molina Healthcare (Austin, TX)
- …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
- CVS Health (Richardson, TX)
- …experience in Pharmacy Benefit Management , Health Insurance, Clinical Utilization Management Products or Prior Authorization . + Experience in leading ... fostering a culture of innovation and collaboration. Owns and advances the pharmacy prior authorization product with the goal of transforming the healthcare… more
- Amergis (Rancho Cordova, CA)
- …management experiencerequired Amergis Healthcare Staffing is seeking a Supervisor Utilization Management Prior Authorization responsible ... Salary: $1760 / Week Supervisor Utilization Management PriorAuthorization Anticipated Duration: ASAP - 3 monthcontract Location Address: Rancho Cordova CA Work… 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
- CVS Health (Springfield, IL)
- …and appeal request. This position is primarily responsible for Utilization Management , including prior authorization as well as concurrent review. ... the Aetna Better Health Plan of Illinois. This UM ( Utilization Management ) Medical Director will be a...in Family Medicine or Internal Medicine / Pediatrics - Prior UM experience working at Health Plan / Insurer… 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
- CVS Health (Charleston, WV)
- …and appeal request. This position is primarily responsible for Utilization Management , including prior authorization and pre certification as well ... Independent Review Organization a Plus **Preferred Qualifications:** -Health plan/payor Utilization Management / Review experience. -Electronic medical… more
- CVS Health (Buffalo Grove, IL)
- …and ongoing departmental and enterprise initiatives. Knowledge of utilization management interventions including prior authorization , step therapy, ... demonstrated prior authorization experience - Demonstrated understanding of utilization management interventions including prior authorization ,… more
- CVS Health (Richmond, VA)
- …and appeal request. This position is primarily responsible for Utilization Management , including prior authorization as well as concurrent review. ... Northeast region but may support other plans when needed. This UM ( Utilization Management ) Medical Director will be a "Work from Home" position primarily… more
- Elevance Health (FL)
- …+ Expertise in legal and regulatory issues affecting utilization management activities, including prior authorization , medical necessity, clinical ... matters impacting Carelon Services businesses, including behavioral health, medical benefits utilization management , specialty care solutions, and care delivery… 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