- Molina Healthcare (Omaha, NE)
- …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. +...Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization… more
- Mohawk Valley Health System (Utica, NY)
- …SNH is responsible for the oversight of the case management staff's authorization /coordination/ utilization and provision of member services. Duties include the ... Provides direct oversight of the case manager's daily operations of utilization review practice, processes and procedures ensuring accurate member care needs… more
- Highmark Health (Monroeville, PA)
- …Maintains a working knowledge of care management, care coordination changes, utilization review changes, authorization changes, contract changes, regulatory ... relationships across the organization in a community setting. **GENERAL OVERVIEW:** Registered nurse who is proficient in the coordination of care and manages… more
- Molina Healthcare (San Jose, CA)
- …financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. + Processes ... California residents preferred.** **EMERGENCY ROOM ADMISSIONS REVIEW NURSE ** **_3-12 DAY SHIFT 7:30AM - 08:30PM PACIFIC...Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization… more
- Penn Medicine (Philadelphia, PA)
- …will ensure access to integrated health care; achieve clinically appropriate authorization to assure optimal reimbursement for the hospital for services provided. ... for pre-cert, patient payments, coverage limitation and determine necessary action prior to patient arrival. Assess information for appropriateness of setting and… more
- University of Utah Health (Salt Lake City, UT)
- …companies, transportation agencies and others as indicated. + Collaborates with social worker/ nurse case manager and others to confirm authorization for services ... of care activities under the direction of a registered nurse and/or social worker. + The incumbent interacts with...+ Documents activities and progress in medical charts, computer billing/ utilization systems, or in other ways as directed. +… more
- Guthrie (Corning, NY)
- …a Bachelor of Arts (BA) degree in addition to a degree in Nursing. A registered nurse with five (5) years relevant experience willing to pursue a BSN or BA degree ... two (2) years of hire. Individual consideration may be given to a registered nurse , with significant clinical experience, who holds a bachelor's degree in a related… more
- CVS Health (Buffalo Grove, IL)
- …compliant and supportive of regulatory and PBM pharmacy guidelines. Knowledge of utilization management interventions including prior authorization , step ... Pittsburgh, PA, or NYC office locations. **Required Qualifications** + Active Registered Nurse (RN) Licensure in good standing + 5+ years of healthcare experience… more
- Magellan Health Services (San Diego, CA)
- …plan, member education and care management. Conducts initial and concurrent review for prior authorization of higher levels of care against medical necessity ... social, and community resources. + Provides telephone triage, crisis intervention and prior authorizations as assigned for select members stratified as high and… more
- PeaceHealth (Bellingham, WA)
- …management of referrals; working closely with team members to ensure optimum utilization and cost containment. Provides clerical support and assistance to staff. ... data entry and completion of referral forms/notifications. Obtains insurance pre- authorization for patients and reauthorization of additional treatment. Ensures… more