- Mayo Clinic (Eau Claire, WI)
- …Competitive retirement package to secure your future. **Responsibilities** The Registered Nurse (RN) Case Manager works within an interdisciplinary team to ... of care throughout the continuum of care by ensuring appropriate utilization management, care coordination, resource utilization , and clinical documentation.… more
- US Tech Solutions (RI)
- …experience required. + Must have experience with Medcompass + Must have prior authorization utilization experience. + Managed Care/Medicare experience ... and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review. + MUST HAVE 1 YEAR OF...knowledge of Milliman/MCG. + MUST HAVE 6 months of Prior Authorization . **Education:** + RN with current… more
- ChenMed (Winter Park, FL)
- …ensuring patients achieve optimal health, access to care and appropriate utilization of resources. + Consults with, encourages and influences physicians, ... coordination, monitoring and evaluation to develop an individualized care plan prior to hospitalization which can result in decreased admissions and hospital… more
- Atlantic Health System (Chatham, NJ)
- …care and touch base with the physicians accordingly. + Coordinate with insurance prior authorization , medication refills and other orders. + Support quality ... in cost management, including product evaluation, prevention of waste/damage, room utilization etc. Coordination of stock management + Demonstrate knowledge of… more
- Sharp HealthCare (La Mesa, CA)
- …referrals for care and services are directed to appropriate network providers, and obtains prior authorization for in network and out of network services as ... Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse (RN) - CA Board of Registered Nursing **Hours** **:** **Shift Start… more
- Sharp HealthCare (San Diego, CA)
- …referrals for care and services are directed to appropriate network providers, and obtains prior authorization for in network and out of network services as ... Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse (RN) - CA Board of Registered Nursing; Accredited Case Manager (ACM)… more
- Eastern Connecticut Health Network (Manchester, CT)
- …for patient movement across the system. Assists with verification of benefits, and prior authorization for services to ensure payment with perspective insurance ... This position works in collaboration with Director of CAT, Nurse Managers, Crisis Services, and Utilization Review....from surrounding hospitals. + Perform insurance benefit verifications and prior authorization for admission. + Ensure all… more
- Humana (Frankfort, KY)
- …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
- Stony Brook University (Stony Brook, NY)
- …with the transferring hospital, Patient Access and physicians and payers for authorization prior to transfer from other hospitals. + Consistent documentation ... the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity...of care from initial assess point. Follows cases for authorization for in patient stay. + Staff review short… 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