- Actalent (Sunrise, FL)
- …to direct utilization and capture data effectively. Responsibilities + Review prior authorization requests for medical necessity and appropriateness, utilizing ... Utilization Management Nurse !Job Description The Utilization Management Nurse ...between the Medical Director, physicians, and office staff, resolving prior authorization issues. + Communicate denial determinations… more
- CVS Health (Oklahoma City, OK)
- …Qualifications** + Experience in **utilization management** , **precertification** , or ** prior authorization ** + Background in **managed care** **Education** + ... a **fully remote role** with a requirement to **reside in Oklahoma** . The nurse in this position uses clinical expertise in a collaborative process to assess, plan,… more
- US Tech Solutions (May, OK)
- …other clinical colleagues, healthcare professionals and members. + * Follow all prior authorization procedures to guarantee an accurate process on each ... policy and procedure. + * Provide on-call after hours nurse availability for urgent PA requests. + * Provide... prior authorization . + * Train and mentor... prior authorization . + * Train and mentor representatives on the… more
- Centene Corporation (New York, NY)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service ... assess medical necessity of care of member + Escalates prior authorization requests to Medical Directors as...RN license required **License/Certification:** + LPN - Licensed Practical Nurse - State Licensure required + RN - Registered… more
- US Tech Solutions (May, OK)
- …pharmacists, other clinical colleagues, healthcare professionals and members. + Follow all prior authorization procedures to guarantee an accurate process on ... following policy and procedure. + Provide on-call after hours nurse availability for urgent PA requests. + Provide internal...each prior authorization . + Train and mentor representatives… more
- US Tech Solutions (LA)
- **Position Summary:** As a Prior Authorization Nurse , you work outside the walls of a hospital setting in a specialty area of the nursing field providing ... utilization management prior authorization reviews. Build strong direct relationships...indicated by staffing and business needs. **Duties:** + **Registered Nurse with current license in LA state of employment.… more
- AssistRx (Orlando, FL)
- …services preferred. + Familiarity with PSP workflows including hub services, copay programs, prior authorization , and nurse support. + Strong understanding ... pharmaceutical and biotech clients. These programs may include field-based nurse support, reimbursement assistance, specialty pharmacy coordination, patient education… more
- Staffing Solutions Organization (Augusta, ME)
- …PA reviews/dispositions based on business rules and workflow policies; + Work with the Prior Authorization unit staff members to monitor work queues and complete ... of our clients and the people they serve. **Registered Nurse - Authorization Review Unit - MaineCare...MaineCare in Augusta, ME** **Position Duties:** + Manage medical Prior Authorizations (PA) as assigned by the PA supervisor,… more
- LifePoint Health (Wilson, NC)
- …opportunities * * *Department/Unit Summary The LPN Testing, Scheduler, and Prior Authorization Coordinator is responsible for coordinating patient testing, ... *Licensed Practical Nurse (LPN), Pulmonary Clinic* Job Type: Full-Time, Days...setting, Gastro experience preferred . Knowledge of insurance policies, prior authorization procedures, and medical terminology. .… 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