- The Cigna Group (Bloomfield, CT)
- **Job Scope** Nurse Clinician/ Registered Nurse II is responsible for reviewing clinical criteria reviews for providers, members and patient client advocates ... within the Prior Authorization /Utilization Management Team. Follows department standard...ethical behavior at all times as outlined by the Nurse Practice Act and applicable company policies. + Review… more
- Molina Healthcare (Springfield, MA)
- …, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... We are looking for a candidate with a MA RN licensure. Candidates with UM Medical Review background and...requested treatments and/or procedures. * Conducts reviews to determine prior authorization /financial responsibility for Molina and its… more
- Evolent (Hartford, CT)
- …Managers to ensure successful adoption and engagement of Evolent's solutions (ie, prior authorization , clinical pathways) to ensure timely patient access to ... and/or practice transformation + Strongly preferred oncology clinical experience (ie, RN , NP) + Must demonstrate knowledge of healthcare delivery operations,… more