- Actalent (Sunrise, FL)
- Actalent is Hiring Multiple Remote HEDIS RN Abstractor Description: Position Purpose: Lead data collection and abstraction for company quality measures, including ... HEDIS, CMS, CHIPRA and/or any other custom measurements. Responsibilities: + Assess vendor-delegated abstraction activities and compare results to HEDIS standards and/or custom or other measure set standards + Review medical records and abstract data for HEDIS… more
- Martin's Point Health Care (Portland, ME)
- …hospital admissions where appropriate.Utilization Review Nurse Key Outcomes: + Review prior authorization requests ( prior authorization , ... a need for inpatient/ outpatient authorizations. This position receives and reviews prior authorization requests for specific inpatient and outpatient medical… more
- Centene Corporation (Atlanta, GA)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Supervises Prior Authorization , Concurrent Review, and/or Retrospective Review ... communication between utilization management team, members, and providers + Monitors prior authorization , concurrent review, and/or retrospective clinical… more
- Commonwealth Care Alliance (Boston, MA)
- …Abilities (must have): * Expertise in managing utilization review processes including prior authorization , concurrent and retrospective reviews * ... Director of Utilization Management * Oversees clinical decision review for services requiring prior authorization in a variety of clinical areas, including but… more
- Independent Health (Buffalo, NY)
- …Degree in Nursing required; Bachelor's degree preferred. Current, active, unrestricted, and licensed registered nurse ( RN ) required. + Two (2) years of ... High Quality, Professional Utilization Management Services: (Medical necessity review for prior authorization , pre-certification, concurrent , as well as… more
- Tenet Healthcare (Detroit, MI)
- Registered Nurse Case Manager Contingent Days - 2506001465 Description : DMC Harper University Hospital has distinguished itself in surgery and medicine and is ... hypertension, stroke prevention and heart failure. Job Description: The RN Case Manager is responsible to facilitate care along...management experience preferred. 3. License to practice as a Registered Nurse in the State of Michigan.… more
- Intermountain Health (Murray, UT)
- …and diagnosis to apply evidence-based guidelines (eg InterQual) and medical policies for prior authorization and concurrent reviews. + Follows the applicable ... + Resourceful + Verbal and Written Communication **Qualifications** Minimum Qualifications + Current RN ( Nurse ) compact license to practice in all states that… more
- Molina Healthcare (Naperville, IL)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
- Banner Health (Phoenix, AZ)
- …met for our wholly owned and delegated plans in the areas of prior authorization , census management, prospective/ concurrent /retro review, and appeals. Care ... require applicable certifications and/or licensures, including but not limited to: RN ; MD or DO; Driver's License; Certified Healthcare Protection Administrator… more
- Sharp HealthCare (La Mesa, CA)
- …**Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA Board of Registered ... care nursing experience or case management experience. + California Registered Nurse ( RN ) - CA...services are directed to appropriate network providers, and obtains prior authorization for in network and out… more
- Access Dubuque (Dubuque, IA)
- …daily utilization functions for assigned patients, including prior authorization , admission, precertification/certification/recertification, concurrent ... Finley Hospital Patient Care Technician-5N Medical/Surgical UnityPoint Health Finley Hospital Clinic RN - Registered Nurse : Oncology/ Palliative MercyOne … more
- Guthrie (Corning, NY)
- …or, a Bachelor of Arts (BA) degree in addition to a degree in Nursing. A registered nurse with five (5) years relevant experience willing to pursue a BSN or ... within two (2) years of hire. Individual consideration may be given to a registered nurse , with significant clinical experience, who holds a bachelor's degree in… more
- Whidbey General Hospital (Coupeville, WA)
- JOB SUMMARY The RN - Care Manager is a health care professional with experience and background to assure compliance with CMS Conditions of Participation regarding ... Utilization Review and Discharge Planning. The RN - Care Manager will lead an assessment to...medical necessity reviews within 24 hours of admission. Completes concurrent inpatient medical necessity reviews daily, unless otherwise specified… more
- Beth Israel Lahey Health (Plymouth, MA)
- …the job that may reasonably be required._ **Education/Experience Required:** _Required_ + State of MA Registered Nurse ( RN ) + 3-5 years acute care nursing + ... the overall transition plan of care based on initial assessment and concurrent collaboration with other care givers, external service organizations, agencies and… more
- Molina Healthcare (Sacramento, CA)
- …financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. + Processes ... **EMERGENCY ROOM ADMISSIONS REVIEW NURSE ** **_3-12 NIGHT SHIFT: 7:30PM - 08:30AM PACIFIC...care/medical experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more
- Sharp HealthCare (La Mesa, CA)
- …Degree in Nursing; Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA Board of Registered ... or equivalent experience in the healthcare setting. + California Registered Nurse ( RN ) - CA...services are directed to appropriate network providers, and obtains prior authorization for in network and out… more
- Arnot Health (Elmira, NY)
- …Auth/Denial Management meetings EDUCATION: RN required. EXPERIENCE: NYS licensed Registered Nurse required. Bachelor's in nursing preferred. Must have ... auth) will review and appeal as appropriate for concurrent and retrospective authorization and denial activities...tracking/trending by payer for denial reason items such as prior authorization , untimely filing, coordination of benefits,… more
- Centene Corporation (Carson City, NV)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... services to ensure level of care and services are medically appropriate + Performs prior authorization reviews related to mental health and substance abuse to… more
- Magellan Health Services (Baton Rouge, LA)
- …- Licensed Professional Counselor - Care Mgmt, LSW - Licensed Social Worker - Care Mgmt, RN - Registered Nurse , State and/or Compact State Licensure - Care ... of care and quality are met. Seeking licensed LPC, LMFT in Louisiana with prior knowledge and experience working in early childhood mental health, or other child… more
- KidsPeace Childrens Hospital (Schnecksville, PA)
- …as necessary collaboration/supervision agreements with Advance Practice Professionals (Certified Registered Nurse Practitioners or Physician Assistants) and ... of standards, insurance company appeals and teleconferences and provision of prior authorization information; e. Participating in the development,… more