- CVS Health (Trenton, NJ)
- …will be on rotation. No travel is required.Applicants from any state can apply. Prior Authorization UM Nurse Consultant Utilizes clinical experience ... in state of residence 3+ years of Nursing experiencePreferred Qualifications Prior authorization utilization experience preferred Outpatient Clinical experience… more
- CVS Health (Topeka, KS)
- …clinical experience + 1+ year(s) of utilization management, concurrent review and/or prior authorization experience + 5+ years of equipment experience including ... phone, computer, and clinical documentation systems + A Registered Nurse that must hold an unrestricted license in the state of Kansas, with multi-state/compact… more
- Kepro (Richmond, VA)
- …assessment and critical thinking skills. + 1+ year of Utilization Review (UR) and/or Prior Authorization or related work experience. + 3+ years of direct ... for health solutions in the public sector. Acentra seeks a Behavioral Health UM Clinical Reviewer (part-time) to join our growing team. Job Summary: Our Behavioral… more
- Sharp HealthCare (San Diego, CA)
- …Day **FTE** 1 **Shift Start Time** **Shift End Time** California Licensed Vocational Nurse (LVN) - CA Board of Vocational Nursing & Psychiatric Technicians; Other ... + Other : Graduate of an accredited Licensed Vocational Nurse (LVN) program + 3 Years experience in the...or home coordinating with the SNF admission liaison for authorization of level of care as appropriate. Assists with… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Role BHPS provides 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,...surgical cases preferred. Essential Qualifications * Current licensed Registered Nurse (RN) with state licensure. Must retain active and… more
- CVS Health (Trenton, NJ)
- …work occasional holiday/weekend rotation per business needs Preferred Qualifications - Prior authorization & utilization management experience - Outpatient ... Medicare/Medicaid - Managed care (MCO) experience - Med Compass experience - CM/ UM Certification Education Associates Degree required BSN preferred Pay Range The… more
- Molina Healthcare (Dallas, TX)
- …benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina ... + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. +...teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional travel to other… more
- AmeriHealth Caritas (Newark, DE)
- …and roll-out of configuration changes. + Have working knowledge of prior authorization , medical necessity determinations, concurrent review, retrospective ... **Utilization Management Plan Oversight Manager, Registered Nurse (must reside in DE)** Location: Newark, DE...and impact on services including but not limited to, prior authorization , inpatient review, discharge planning, home… more
- Baystate Health (Springfield, MA)
- …issues, specifically related to outlier cases, long LOS cases or complicated prior authorization requests + Understand member insurance products and benefits, ... **Position** Licensed Practical Nurse **SCHEDULE:** + Full time + Monday -...benefits education, and HNE's medical policy requirements related to prior authorization requirements. + Interact with external… more
- Humana (Montgomery, AL)
- …policies and procedures. + Assisting/educating facility staff regarding Humana's processes for prior authorization , observation status, etc. **Use your skills to ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and… more
- US Tech Solutions (May, OK)
- …experience . Registered Nurse in state of residence . Must have prior authorization utilization experience . Able to work in multiple IT platforms/systems ... MANAGED CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review. . MUST HAVE...knowledge of Milliman/MCG. . MUST HAVE 6 months of Prior Authorization . Education: . Active and unrestricted… more
- CVS Health (Phoenix, AZ)
- …clinical information from providers. Required Qualifications + 1+ year: Oncology and Transplant UM , concurrent review or prior authorization + 3+ years: ... training required 100% participation during 8:30am-5pm Monday-Friday EST. + A Registered Nurse that must hold an unrestricted license in their state of residence,… more
- US Tech Solutions (RI)
- …experience required. + Must have experience with Medcompass + Must have prior authorization utilization experience. + Managed Care/Medicare experience preferred. ... MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review. + MUST HAVE...knowledge of Milliman/MCG. + MUST HAVE 6 months of Prior Authorization . **Education:** + RN with current… 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 ... responsible for coordinating the daily operations of the UM Pre- Authorization team in order to ensure requests are processed in a consistent and timely manner… more
- Sanford Health (Sioux Falls, SD)
- …activities relating to the implementation, ongoing evaluation, and improvements to UM and/or prior authorization processes with applicable. ... regulations and internal policies that effect resource utilization and potentially, prior authorization . Assists the department in monitoring the utilization… more
- YesCare Corp (Bartow, FL)
- … hospital experience with five (5) years corrections experience + Minimum of two (2) years prior experience with UM preferred + Minimum of one (1) year prior ... **Experience & Requirements** + Licensed Registered Professional Nurse currently registered to practice in state of...+ Serves as resource to sites and providers for authorization numbers + Forwards daily inpatient case management abstracts… more
- Molina Healthcare (Long Beach, CA)
- …financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. + Processes ... **JOB TITLE: CARE REVIEW CLINICIAN INPATIENT REVIEW : REGISTERED NURSE ** **For this position we are seeking a (RN)...teams to promote Molina Care Model. + Adheres to UM policies and procedures. + Occasional travel to other… more
- Molina Healthcare (Omaha, NE)
- …financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. + Processes ... For this position we are seeking a (RN) Registered Nurse who resides in and is licensed in the...teams to promote Molina Care Model. + Adheres to UM policies and procedures. + Occasional travel to other… more