- Molina Healthcare (Albuquerque, NM)
- …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. +...Any of the following: Completion of an accredited Registered Nurse (RN), Licensed Vocational Nurse (LVN) or… more
- Molina Healthcare (Albuquerque, NM)
- …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
- Veterans Affairs, Veterans Health Administration (Albuquerque, NM)
- …a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion of the bridge program. ... Summary Community Care is seeking Nurse Case Managers to join our team! This...and expertise for the coordination of NMVAHCS non-VA care authorization program. Demonstrate knowledge of Fee federal regulations, VHA… more
- Humana (Santa Fe, NM)
- …outcomes of our members. + _Outcomes_ : Characterize the impactable drivers of prior authorization and Success in driving consistent and quality outcomes for ... 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 (Santa Fe, NM)
- …of stay for requested treatments and/or procedures. + Conducts reviews to determine prior authorization / financial responsibility for Molina healthcare and its ... relevant education and experience. + Active and unrestricted Registered Nurse (RN) license in state of practice. + May...Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization… more
- Molina Healthcare (Las Cruces, NM)
- …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
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