- 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
- CenterWell (Tallahassee, FL)
- …member service or customer service telephone experience desired + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care ... of our caring community and help us put health first** The Utilization Management (UM) Administrative Coordinator 2 is responsible for providing high-quality support… more
- CVS Health (Sacramento, CA)
- …Qualifications** + Direct clinical experience in a hospital setting or prior Utilization Management experience. + Valid California unrestricted independent ... skills to coordinate, document and communicate all aspects of the utilization /benefit management program for preauthorization for mental health services. Applies… 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 (Austin, TX)
- …with Microsoft Office applications (Outlook, Teams, Excel) **Preferred Qualifications** + Prior Authorization or Utilization Management experience + Managed care ... schedules will include holidays and evening hours._ Medicare Precertification Utilization Management Nurse Consultant position: + Utilizes clinical experience and… more
- CVS Health (Springfield, IL)
- …Must be willing to work 8-5pm local time. **Preferred Qualifications** + Prior authorization utilization experience preferred + Outpatient Clinical experience + ... opportunities to promote quality effectiveness of Healthcare Services and benefit utilization + Consults and lends expertise to other internal and external… more
- CVS Health (Lansing, MI)
- …Microsoft Office Applications (Outlook, Teams, Excel) **Preferred Qualifications** + Prior authorization utilization experience preferred + Outpatient Clinical ... And we do it all with heart, each and every day. ** Utilization Management Nurse Consultant** Fully Remote- WFH **Position Summary** Utilizes clinical experience… 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
- Humana (Richmond, VA)
- …enhanced licensure, (eNLC) without disciplinary action + 1+ year previous experience in utilization management + 2+ years prior clinical experience preferably in ... a part of our caring community and help us put health first** The Utilization Management (UM) Nurse 2 RN utilizes clinical nursing skills to support the… 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