- Humana (Santa Fe, NM)
- …a team **Preferred Qualifications** + Bachelor's degree + Previous experience in prior authorization , claims, and/or utilization management in healthcare, ... a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- CVS Health (Santa Fe, NM)
- …1 year of Utilization Management experience in concurrent review or prior authorization . + Strong decision-making skills and clinical judgment in independent ... high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join...+ Experience in a high-volume clinical call center or prior remote work environment. **Education** + Associate's degree in… more
- CVS Health (Santa Fe, NM)
- …1 year of Utilization Management experience in concurrent review or prior authorization . + Strong decision-making skills and clinical judgment in independent ... for members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our...+ Experience in a high-volume clinical call center or prior remote work environment. **Education** + Associate's degree in… 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. +...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
- 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
- Prime Therapeutics (Santa Fe, NM)
- …outreach and review of medical records to audit authenticity of provider response during Prior Authorization and reporting results to client. + Assists with the ... cardholders, and pharmacies. + Escalates medical exception requests to nurse , pharmacist or physician on the utilization ...to nurse , pharmacist or physician on the utilization review clinical team when further review is necessary.… more
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