- Elevance Health (San Antonio, TX)
- …and personalized support throughout the consumer's treatment journey. **Title:** Utilization Management Representative II - Prior Authorization **Location:** ... immediate support. **Build the Possibilities. Make an extraordinary impact.** The Utilization Management Representative II - Prior Authorization is responsible… more
- Sanford Health (SD)
- …regarding trends, external regulations and internal policies that effect resource utilization and potentially, prior authorization. Assists the department in ... level of care medical necessity reviews within patient's medical records. Performs utilization management (UM) activities in accordance with UM plan to assure… more
- Cleveland Clinic (Cleveland, OH)
- …for the ideal future caregiver include: + Case Management Certification (CCM) + Prior Utilization Management experience Our caregivers continue to create the ... most respected healthcare organizations in the world. As a Utilization Management Specialist, you will perform UM activities, such...who excels in this role will: + Recommend resource utilization . + Prioritizes and organizes work to meet changing… more
- Queen's Health System (Honolulu, HI)
- …Emma Clinics (QEC). * Performs duties and responsibilities in accordance with utilization tracking and prior authorization procedures. * Assists with ... RESPONSIBILITIES I. JOB SUMMARY/RESPONSIBILITIES: * Coordinates and maintains the utilization review process for clinical services including medical, surgical and… more
- US Tech Solutions (Chicago, IL)
- …as an RN + Registered Nurse in state of residence + Must have prior authorization utilization experience + Experience with Medcompass **Skills:** + MUST HAVE ... and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review. + MUST HAVE 1 YEAR OF...Prior Authorization? + Do you have experience with Utilization Review? + Do you have an Active Registered… more
- US Tech Solutions (May, OK)
- …inpatient hospital experience . Registered Nurse in state of residence . Must have prior authorization utilization experience . Able to work in multiple IT ... and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review. . MUST HAVE 1 YEAR OF...knowledge of Milliman/MCG. . MUST HAVE 6 months of Prior Authorization. Education: . Active and unrestricted RN licensure… more
- CVS Health (Jackson, MS)
- …+ 3+ years of Nursing experience. Preferred Qualifications + Prior authorization utilization management/review experience preferred Outpatient Clinical ... opportunities to promote quality effectiveness of Healthcare Services and benefit utilization . + Consults and lends expertise to other internal and external… more
- Sanford Health (ND)
- …- $28.00 **Department Details** Opportunity to work remote **Job Summary** Monitors the utilization of resources, risk management and quality of care for patients in ... accordance to established guidelines and criteria for designated setting and status. Collection of clinical information necessary to initiate commercial payor authorization. Obtain and maintain appropriate documentation concerning services in accordance to… more
- Katmai (Fort Carson, CO)
- …of Science in Nursing (BSN) is required. + Minimum of two (2) years of prior experience in Utilization Management. + Must possess a current, active, full, and ... checks. **DESIRED QUALIFICATIONS & SKILLS** + Certification by a Utilization Management-specific program such as Certified Professional in Healthcare Management… more
- Molina Healthcare (Columbus, OH)
- …license in good standing Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of ... and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare… more
- Molina Healthcare (Long Beach, CA)
- …meetings. **Preferred Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and ... and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare… more
- Elevance Health (Indianapolis, IN)
- …the state employed. **Preferred Skills, Capabilities and Experiences** + **Leadership & Utilization Management:** Prior leadership role in a managed care ... Woodland Hills, CA. **Summary** The Behavioral Health Chief Medical Officer oversees Utilization Review, Peer Review and the Regional CMO's and Medical Directors.… more
- Catholic Health (Buffalo, NY)
- …+ Two (2) years medical surgical nursing and/or job related experience + Preferred prior insurance /managed care/ utilization review experience in the role of a ... Hours: 8:00 am to 4:00 pm Summary: The Registered Nurse (RN) Care Manager- Utilization Review, as an active member of the Care Management and interdisciplinary care… more
- US Tech Solutions (LA)
- …a hospital setting in a specialty area of the nursing field providing utilization management prior authorization reviews. Build strong direct relationships with ... + Minimum 3 years nursing experience with a minimum of 1 year in utilization management/ prior authorization review experience. **Experience** : Utilization … more
- Molina Healthcare (Lincoln, NE)
- …performing one or more of the following activities: care review/ utilization management ( prior authorizations, inpatient/outpatient medical necessity, etc.), ... Collates and reports on Care Access and Monitoring statistics including plan utilization , staff productivity, cost effective utilization of services, management… more
- Elevance Health (Los Angeles, CA)
- …with facility-based and/or outpatient psychiatric and chemical dependency treatment and prior utilization management experience, which includes a minimum of ... **Manager II Behavioral Health Services** will be responsible for Behavioral Health Utilization Management (BH UM), or Behavioral Health Case Management (BH CM) or… more
- Brockton Hospital (Brockton, MA)
- …management experience Proven experience in coordinating discharge planning and utilization review experience required. Prior management experience required. ... and effective delivery of patient care services through the appropriate utilization of healthcare resources. Participates in daily care rounds to collaborate… more
- Bayer (Portsmouth, NH)
- …teams monitor trends and utilization of patient support services and utilization management (ie: prior authorization submissions & approvals); + Partner with ... to maximize HP/PBM Pull Through opportunities; + Special emphasis on consistent utilization of DRPAs as conduit to field sales action, and opportunity Assessment;… more
- Evolent (Columbus, OH)
- …and stakeholders. + Familiarity with healthcare claims, reimbursement methodologies, and cost/ utilization KPIs, including prior authorization data and key ... : Analyze healthcare claims and authorization data to identify cost drivers, utilization trends, and population health opportunities using SAS, SQL, Excel, and Power… more
- Molina Healthcare (Everett, WA)
- …state health plan's Healthcare Services (clinical operations) teams including Utilization Management ( prior -authorization, inpatient review) and Care Management ... unrestricted State Registered Nursing (RN) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality… more