- Centene Corporation (New York, NY)
- …have an active New York State nursing License.** **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service ... medical necessity of care of member + Escalates prior authorization requests to Medical ...management processes preferred. **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
- ManpowerGroup (Austin, TX)
- …services in Texas. This is a non-clinical, **remote** -review role focused on ** prior authorization ** and **utilization management** -ideal for RNs who thrive in ... We're seeking a dedicated and detail-oriented **Registered Nurse (RN)** to join a dynamic healthcare partnership team supporting Medicaid… more
- CVS Health (Oklahoma City, OK)
- …Qualifications** + Experience in **utilization management** , **precertification** , or ** prior authorization ** + Background in **managed care** **Education** + ... with a requirement to **reside in Oklahoma** . The nurse in this position uses clinical expertise in a...our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Pre- Authorization Nurse 2 reviews prior authorization requests for appropriate ... and approves services or forward requests to the appropriate stakeholder. The Pre- Authorization Nurse 2 + Completes medical necessity and level of care… more
- Select Medical (West Orange, NJ)
- …Rehabilitation - West Orange** A Select Medical Hospital West Orange, NJ ** Prior Authorization Specialist/ Payor Relations Specialist ( RN , LPN )** ... and independent judgment, the Payor Relations Specialist manages the pre-certification and prior authorization of referrals scheduled for admission to the Acute… more
- University of Miami (Miami, FL)
- …Review Case Manager RN - Full Time The University of Miami is currently seeking a Prior Authorization Nurse Case Manager. The incumbent purose is to conduct ... medical necessity and identify the need for authorization . The nurse coordinates with the healthcare...Adhere and perform timely prospective reviews for services requiring prior authorization + Follows the authorization… more
- Molina Healthcare (Southaven, MS)
- …and its members. + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
- Molina Healthcare (Buffalo, NY)
- …and its members. + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
- Molina Healthcare (Idaho Falls, ID)
- …and its members. + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more