- Humana (Atlanta, GA)
- …**3+ years of Skilled Nursing Facility experience and or Previous experience in utilization management** + Prior clinical experience preferably in an acute care, ... part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to support the… more
- Humana (Dover, DE)
- …new systems (proficient to advanced) **Preferred Qualifications** + Experience with Utilization Review and/or Prior Authorization, preferably within a managed ... first** The UM Administration Coordinator contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities… more
- Molina Healthcare (NM)
- …an integrated Care Access and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review, and/or other ... environment. + Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of InterQual /… more
- US Tech Solutions (Chicago, IL)
- …as an RN + Registered Nurse in state of residence + Must have prior authorization utilization experience + Experience with Medcompass **Skills:** + MUST HAVE ... and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review. + MUST HAVE 1 YEAR OF...Prior Authorization? + Do you have experience with Utilization Review? + Do you have an Active Registered… more
- CVS Health (Raleigh, NC)
- …11:00AM to 8:30pm EST with occasional holiday rotation.** **Preferred Qualifications** + Prior Authorization or Utilization Management experience + Managed care ... with heart, each and every day. **Position Summary** Medicare Precertification Utilization Management Nurse Consultant position: _Utilization Management is a 24/7… more
- US Tech Solutions (May, OK)
- …inpatient hospital experience . Registered Nurse in state of residence . Must have prior authorization utilization experience . Able to work in multiple IT ... 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: . Active and unrestricted RN licensure… more
- CVS Health (Pittsburgh, PA)
- …long-term and ongoing departmental and enterprise initiatives. Knowledge of utilization management interventions including prior authorization, step therapy, ... of managed care experience - 3+ years relevant work experience or prior authorization experience - Demonstrated understanding of utilization management… more
- Centene Corporation (Columbus, OH)
- …BUT CANDIDATE MUST RESIDE IN STATE OF OHIO IDEAL CANDIDATE WILL HAVE PRIOR AUTHORIZAION OR UTILIZATION MANAGEMENT EXPERIENCE PEOPLE LEADER EXPERIENCE STRONGLY ... utilization management team, members, and providers + Monitors prior authorization, concurrent review, and/or retrospective clinical review nurses and ensures… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …electronic health records and clinical documentation systems. **Preferred Qualifications** + Prior experience in utilization management, case review, or ... **POSITION PURPOSE** . The Board Certified Behavior Analyst (BCBA), Utilization Reviewer role is responsible for evaluating the medical...drug screening after an offer has been extended and prior to hire for all positions. As part of… more
- Molina Healthcare (Idaho Falls, ID)
- …standing. **Preferred Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and ... and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare… more