- Centene Corporation (Tallahassee, FL)
- …a fresh perspective on workplace flexibility. **Centene is Hiring - Remote Clinical Review Nurse ( Prior Authorization )!** **Ready to take your nursing career ... looking for:** + **RN or LPN with a compact license** + **Experience in prior authorization (managed care or clinical setting)** **Make your nursing background… 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 ... interdepartmental teams, to assess medical necessity of care of member + Escalates prior authorization requests to Medical Directors as appropriate to determine… more
- Actalent (Sunrise, FL)
- …direct utilization and capture data effectively. Responsibilities + Review prior authorization requests for medical necessity and appropriateness, utilizing ... Utilization Management Nurse !Job Description The ...between the Medical Director, physicians, and office staff, resolving prior authorization issues. + Communicate denial determinations… more
- Actalent (Sunrise, FL)
- …satisfaction, safety, and appropriate length of stay. Responsibilities + Review prior authorization requests for medical necessity and appropriateness using ... Actalent is hiring a Utilization Management Nurse ! Job Description The...with the interdisciplinary team to perform reviews of service authorization requests, ensuring the utilization of appropriate… more
- Humana (Lansing, MI)
- … utilization management (UM) operations and the State of Michigan regarding prior authorization reviews, prepayment retrospective reviews, and any additional ... caring community and help us put health first** The Utilization Management Nurse Lead uses clinical knowledge,...oversight to support the supervision and daily guidance of prior authorization associates ensuring outcomes that meet… more
- Martin's Point Health Care (Portland, ME)
- …for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental policies as well as ... "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member...for inpatient/ outpatient authorizations. This position receives and reviews prior authorization requests for specific inpatient and… more
- CVS Health (Montgomery, AL)
- …to 4 hours a day working with providers to secure additional information for prior authorization review. + This candidate will utilize clinical skills to ... ( utilization management) experience within an **outpatient** setting, concurrent review or prior authorization . + 5 years of a variety clinical experience… more
- US Tech Solutions (Chicago, IL)
- …as an RN + Registered Nurse in state of residence + Must have prior authorization utilization experience + Experience with Medcompass **Skills:** + MUST ... + Do you have experience with Prior Authorization ? + Do you have experience with Utilization... Review? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech Solutions… more
- CVS Health (Carson City, NV)
- …1 year of Utilization Management experience in concurrent review or prior authorization . + Strong decision-making skills and clinical judgment in independent ... 2 to 4 hours a day working with providers to secure additional information for prior authorization review. **Remote Work Expectations** + This is a 100% remote… more
- CVS Health (Oklahoma City, OK)
- …opportunities to promote quality effectiveness of healthcare services and benefit utilization . + Consults and lends expertise to other internal and external ... constituents in the coordination and administration of the utilization /benefit management function. + There are standard productivity and quality expectations. +… more