- Texas A&M University System (College Station, TX)
- Job Title Registered Nurse II - Prior Authorization & Referral Agency Texas A&M University Health Science Center Department University Health Services ... team-based health care delivery. What we want The Registered Nurse II- Prior Authorization and Referral,...experience in at least one of the following areas: Prior authorizations or utilization management , c… more
- Centene Corporation (Austin, TX)
- …or utilization review experience (preferred)_** **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service and ... interdepartmental teams, to assess medical necessity of care of member + Escalates prior authorization requests to Medical Directors as appropriate to determine… more
- Elevance Health (Grand Prairie, TX)
- …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
- Centene Corporation (Austin, TX)
- …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
- Baylor Scott & White Health (Austin, TX)
- …Benefits may vary based on position type and/or level **Job Summary** As the Utilization Review RN you will review patient cases for medical necessity and establish ... specific rate will depend upon the successful candidate's specific qualifications and prior experience. **Essential Functions of the Role** + You will review medical… more
- Molina Healthcare (Houston, TX)
- …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 (Austin, TX)
- …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 (Fort Worth, TX)
- …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 (Fort Worth, TX)
- …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
- HCA Healthcare (Jourdanton, TX)
- …applicable). Minimum License, Certificates, or Registrations Required: ONE of the following prior to the first day of employment: A. Current Registered Pharmacist ... Licensed pharmacist in another state: Provide proof of the Authorization to Test (ATT) from the Texas State Board...as needed to include timely notification of physician and nurse . 3. Provides continual guidance to technical staff as… more
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