• Behavioral Health Professional…

    Humana (Baton Rouge, LA)
    …an acute or outpatient behavioral health setting + Experience with Utilization Management or Prior Authorization + Experience with behavioral change, ... part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional utilizes behavioral health knowledge and… more
    Humana (08/08/25)
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  • Registered Nurse

    US Tech Solutions (LA)
    …walls of a hospital setting in a specialty area of the nursing field providing utilization management prior authorization reviews. Build strong direct ... Minimum 3 years nursing experience with a minimum of 1 year in utilization management / prior authorization review experience. **Experience** : … more
    US Tech Solutions (07/18/25)
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  • Concurrent Review Nurse

    Actalent (New Orleans, LA)
    …successful completion of cases. Essential Skills + Experience in utilization management , concurrent review, prior authorization , utilization review, ... planning. + Proficiency with InterQual. + Active Compact RN License. + Utilization Management /Concurrent Review experience. + ICU/ER experience. + Strong… more
    Actalent (08/08/25)
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  • Pre- Authorization Specialist…

    CaroMont Health (Gastonia, NC)
    …Summary: The Pre- Authorization Specialist is a member of the Utilization Review Department who is responsible for verifying eligibility, obtaining insurance ... benefits, and ensuring pre-certification, authorization , and referral requirements are met prior to the delivery of inpatient, outpatient, and ancillary… more
    CaroMont Health (08/08/25)
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  • LPN Supervisor, Care Review Prior

    Molina Healthcare (Tacoma, WA)
    …+ Oversees an integrated Care Access and Monitoring team responsible for prior authorizations and/or other utilization management activities aimed ... are seeking a candidate with a WA state LPN licensure. Candidates with previous prior authorization and MCO experience are highly preferred. Further details to… more
    Molina Healthcare (08/08/25)
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  • Clinical Review Nurse - Prior

    Actalent (Eugene, OR)
    Job Title: Clinical Review Nurse - Prior Authorization Job Description This role involves analyzing all prior authorization requests to determine the ... the medical necessity of care for members. + Escalate prior authorization requests to Medical Directors as...Knowledge of Medicare and Medicaid regulations. + Knowledge of utilization management processes. Work Environment This position… more
    Actalent (08/08/25)
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  • Clinical Review Nurse - Prior

    Actalent (Eugene, OR)
    …Review Nurse - Prior AuthorizationJob Description This role involves analyzing prior authorization requests to assess the medical necessity of services and ... to assess medical necessity for member care. + Escalate prior authorization requests to Medical Directors when...Knowledge of Medicare and Medicaid regulations + Familiarity with utilization management processes + True care experience… more
    Actalent (08/09/25)
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  • LPN Care Review Clinician, UM Prior

    Molina Healthcare (Spokane, WA)
    …are seeking a candidate with a WA state LPN licensure. Candidates with case management , Utilization Management (UM), and direct managed care experience are ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
    Molina Healthcare (08/08/25)
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  • Utilization Management Nurse

    Actalent (Sunrise, FL)
    Actalent is hiring a Utilization Management Nurse! Job Description The Utilization Management Nurse (UMN) collaborates closely with the interdisciplinary ... safety, and appropriate length of stay. Responsibilities + Review prior authorization requests for medical necessity and...activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management more
    Actalent (07/29/25)
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  • Utilization Management Nurse…

    CVS Health (Baton Rouge, LA)
    management ) experience within an inpatient, concurrent review or prior authorization . + Remote work experience. **Education** + Associate degree ... is URAC accredited in Case Management , Disease Management and Utilization Management . AHH...day working with providers to secure additional information for prior authorization review. This candidate will utilize… more
    CVS Health (07/30/25)
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