• Utilization Management Nurse…

    CVS Health (Raleigh, NC)
    …8:30pm EST with occasional holiday rotation.** **Preferred Qualifications** + Prior Authorization or Utilization Management experience + Managed care ... all with heart, each and every day. **Position Summary** Medicare Precertification Utilization Management Nurse Consultant position: _Utilization Management more
    CVS Health (08/28/25)
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  • Clinical Pharmacist - Utilization

    CVS Health (Pittsburgh, PA)
    …and ongoing departmental and enterprise initiatives. Knowledge of utilization management interventions including prior authorization , step therapy, ... or prior authorization experience - Demonstrated understanding of utilization management interventions including prior authorization , step… more
    CVS Health (08/20/25)
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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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  • 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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  • Manager, Prior Authorization RN

    Fallon Health (Worcester, MA)
    …follow us on Facebook, Twitter and LinkedIn. **Brief Summary of Purpose:** The Manager, Prior Authorization RN manages all staffing and activities related to ... prior authorization which includes but is not...benefit review. Along with other members of the medical management leadership team, the Manager is responsible for the… more
    Fallon Health (08/14/25)
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  • Prior Authorization and Referral…

    St. Luke's University Health Network (Orwigsburg, PA)
    …serve, regardless of a patient's ability to pay for health care. The Network Prior Authorization and Referral Specialist is responsible for the coordination of ... information. + Provides insurance company with clinical information necessary to secure prior - authorization or referral. + Works in alignment with Central… more
    St. Luke's University Health Network (08/19/25)
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  • Pharmacy Prior Authorization

    Kelly Services (Rochester, NY)
    **Kelly(R) is looking for a Pharmacy Prior Authorization Technician to work at a top insurance client in the Rochester, NY area. Let us help you grow at work and ... weekend beginning no later than January 2026 **Summary Description** The Pharmacy Prior Authorization Technician performs initial-level processing and review of … more
    Kelly Services (08/19/25)
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  • Clinical Review Nurse - Prior

    Centene Corporation (Jefferson City, MO)
    …Role has weekend and holiday rotations. _** **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service and ... interdepartmental teams, to assess medical necessity of care of member + Escalates prior authorization requests to Medical Directors as appropriate to determine… more
    Centene Corporation (08/27/25)
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  • Supervisor, Utilization Management

    Centene Corporation (Columbus, OH)
    …REMOTE BUT CANDIDATE MUST RESIDE IN STATE OF OHIO IDEAL CANDIDATE WILL HAVE PRIOR AUTHORIZAION OR UTILIZATION MANAGEMENT EXPERIENCE PEOPLE LEADER EXPERIENCE ... on key initiatives and to facilitate on-going communication between utilization management team, members, and providers + Monitors prior authorization ,… more
    Centene Corporation (08/23/25)
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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 (08/21/25)
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