- 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
- CVS Health (Lansing, MI)
- …schedule 8a-5pm Est time.) No travel is required.Applicants from any state can apply. Prior Authorization UM Nurse Consultant Utilizes clinical ... in state of residence 3+ years of Nursing experiencePreferred Qualifications Prior authorization utilization experience preferred Outpatient Clinical experience… more
- Sharp HealthCare (San Diego, CA)
- …the benefit guidelines to approve referral requests as outlined in the SCMG prior authorization document and desktop procedures.Research and assist in the ... Evidence of Coverage (EOC), health plan coverage criteria, etc. + Prior Authorization Obtain necessary medical/clinical information utilizing multiple sources… more
- CVS Health (Lansing, MI)
- …Ability to work in a fast paced environment Preferred Qualifications + Previous prior authorization experience Education + Associates degree required + BSN ... preferred Pay Range The typical pay range for this role is: $29.10 - $62.31 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will… 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
- 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
- Billings Clinic (Billings, MT)
- …CM, and department leadership *Conducts UR until all tasks are completed; indicates UM Complete in authorization and/or certification *Communicates with payer UR ... Requirements All new employees must complete several pre-employment requirements prior to starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more!… more
- Carle (Urbana, IL)
- …Advantage in all service areas. Medical Utilization management functions include prior authorization , inpatient care management, outcome data, file audits, ... Utilization Management Coord + Department: HA - Medical UM & Systems + Entity: Health Alliance +...and assisting as needed with clinical issues. + Performs prior authorization process, inpatient review, and retrospective… more
- Molina Healthcare (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