- Actalent (Sunrise, FL)
- …direct utilization and capture data effectively. Responsibilities + Review prior authorization requests for medical necessity and appropriateness, utilizing ... Utilization Management Nurse !Job Description The ...between the Medical Director, physicians, and office staff, resolving prior authorization issues. + Communicate denial determinations… more
- Actalent (Sunrise, FL)
- …satisfaction, safety, and appropriate length of stay. Responsibilities + Review prior authorization requests for medical necessity and appropriateness using ... Actalent is hiring a Utilization Management Nurse ! Job Description The...with the interdisciplinary team to perform reviews of service authorization requests, ensuring the utilization of appropriate… more
- CVS Health (Tallahassee, FL)
- …to 4 hours a day working with providers to secure additional information for prior authorization review. + This candidate will utilize clinical skills to ... ( utilization management) experience within an **outpatient** setting, concurrent review or prior authorization . + 5 years of a variety clinical experience… more
- Elevance Health (FL)
- … Management Representative I** is responsible for coordinating cases for precertification and prior authorization review. **How will you make an impact:** + ... ** Utilization Management Representative I** **Location:** Virtual: This role...provides authorization for inpatient admission, outpatient precertification, prior authorization , and post service requests. +… more
- Centene Corporation (Tallahassee, FL)
- …services to ensure level of care and services are medically appropriate + Performs prior authorization reviews related to mental health and substance abuse to ... Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Molina Healthcare (Tampa, FL)
- …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. +...Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization… more
- Humana (Tallahassee, FL)
- …health outcomes of our members. + _Outcomes_ : Characterize the impactable drivers of prior authorization and look at appeals rate with denials and overturns. ... Utilization Management of medical review by physician or nurse , with a focus on our 5+ million Medicare..._Access_ _:_ Ensure Humana members have fair and consistent authorization review and ability to appeal and have justification… more
- Molina Healthcare (Tampa, FL)
- …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. +...Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization… more