- Network Health WI (Menasha, WI)
- …principles, procedures, requirements, regulations, and policies Evaluate and process prior authorization requests/referrals submitted from contracted and ... The RN Coordinator Utilization Management reviews submitted authorization requests... (RN) required Experience in insurance, managed care, and utilization management preferred Current Registered Nurse (RN)… more
- Mindful Care (New York, NY)
- We are seeking Board Certified Psychiatric Mental Health Nurse Practitioners (PMHNP) to expand access to behavioral health care in your area. If you're passionate ... while maintaining control over their schedule. We handle patient scheduling, prior authorizations, case management, billing, and other support functions. Our… more
- KMA Human Resources Consulting (South Portland, ME)
- …clinical direction for patients when their physicians are unavailable. Participates in utilization review and prior authorization requests. Supports ... Chest Medicine Associates Physician Assistantor Nurse Practitioner South Portland, Maine Chest Medicine Associates...Chest Medicine Associates is seeking a Physician Assistant or Nurse Practitioner to be based in the South Portland… more
- Carle Health (Urbana, IL)
- …with 1 or more years experience - External Applicants Only The staff Registered Nurse (RN) is a professional caregiver who assumes responsibility for a group of ... a designated time frame and provides care to these patients via the utilization of the nursing process, nursing trends, technology, financial and human resources… more
- 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 (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
- 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
- Adecco US, Inc. (Minneapolis, MN)
- …or 5+ years nursing experience . Relevant experience in UM process activities such as prior authorization or medical claims review . Resides in Texas **Why work ... : $40.00 - $43.25 per hour based on experience **Responsibilities of the Utilization Management Nurse ** : . Responsible for reviewing proposed hospitalization,… more
- Commonwealth Care Alliance (Boston, MA)
- …clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA ... Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization ...+ Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical… more
