- Centene Corporation (New York, NY)
- …**8:30am-5pm, Monday-Friday Eastern Standard hours.** **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of ... interdepartmental teams, to assess medical necessity of care of member + Escalates prior authorization requests to Medical Directors as appropriate to determine… more
- CDPHP (Albany, NY)
- …responsible for the clinical review and documentation for services requiring prior authorization . This includes approval determinations and appropriate ... of acute care experience is required as a Registered Nurse . + Minimum of two (2) years Utilization... Nurse . + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of coding/claims… more
- Elevance Health (Latham, NY)
- …eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization , and post service requests. + Obtains intake ... ** Utilization Management Representative II** **Virtual:** This role enables...to screen basic and complex requests for precertification and/or prior authorization . + Verifies benefits and/or eligibility… more
- Elevance Health (Latham, NY)
- …Management Representative I** will be responsible for coordinating cases for precertification and prior authorization review. **How you will make an impact:** + ... ** Utilization Management Representative I** **Virtual:** This role enables...provides authorization for inpatient admission, outpatient precertification, prior authorization , and post service requests. +… more
- Molina Healthcare (NY)
- …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 (Albany, NY)
- …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
- Stony Brook University (Stony Brook, NY)
- …with the transferring hospital, Patient Access and physicians and payers for authorization prior to transfer from other hospitals. + Consistent documentation ... the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity...of care from initial assess point. Follows cases for authorization for in patient stay. + Staff review short… more
- Molina Healthcare (Yonkers, NY)
- …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
- Mohawk Valley Health System (Utica, NY)
- …SNH is responsible for the oversight of the case management staff's authorization /coordination/ utilization and provision of member services. Duties include the ... Provides direct oversight of the case manager's daily operations of utilization review practice, processes and procedures ensuring accurate member care needs… more
- Guthrie (Corning, NY)
- …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 BA degree ... 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 a related… more
Recent Jobs
-
Loss Prevention Site Lead
- Amazon (Union City, GA)
-
Child And Youth Program Assistant (Entry Level)
- Air Combat Command (Offutt AFB, NE)
-
Medicare Customer Satisfaction Advocate
- Kelly Services (Greece, NY)
-
Senior Associate Civil Engineer-Design
- City of Detroit (Detroit, MI)