- AdventHealth (Orlando, FL)
- …+ Bachelors degree in Nursing + Health-related masters degree or MSN + Prior Care Management/ Utilization Management experience + Professional Certification This ... of the implementation of the transitions of care plans prior to the discharge of the patient. The RN...physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge… more
- Dartmouth Health (Bennington, VT)
- …RN license and currently matriculated into a BSN program may be considered. Prior experience in utilization review, discharge planning and/or case management ... Five years of clinical nursing experience and BS required. BSN preferred. Prior experience in utilization review, discharge planning and/or case management… more
- Dartmouth Health (Bennington, VT)
- …RN license and currently matriculated into a BSN program may be considered. Prior experience in utilization review, discharge planning and/or case management ... Five years of clinical nursing experience and BS required. BSN preferred. Prior experience in utilization review, discharge planning and/or case management… more
- University of Miami (Miami, FL)
- …of UMHC SCCC Business Operations has an exciting opportunity for a full time Utilization Review Case Manager to work to work remote. The incumbent conducts initial, ... concurrent and retrospective chart reviews for clinical utilization and authorization. The Utilization Review Case Manager coordinates with the healthcare team… more
- Molina Healthcare (Everett, WA)
- …candidate with a WA state LPN licensure. Candidates with case management, Utilization Management (UM), and direct managed care experience are highly preferred. ... and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare… more
- AdventHealth (Deland, FL)
- …qualifications:** + BSN + Health-related Master's degree or MSN + Prior Care Management/ Utilization Management experience ACM/CCM Certification This facility ... of the implementation of the transitions of care plans prior to the discharge of the patient. The RN...physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge… more
- AdventHealth (Hinsdale, IL)
- …PREFERRED:** . BSN . Health-related Master's degree or MSN . Prior Care Management/ Utilization Management experience **LICENSURE, CERTIFICATION OR REGISTRATION ... of the implementation of the transitions of care plans prior to the discharge of the patient. The RN...physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge… more
- St. Luke's University Health Network (Orwigsburg, PA)
- …regardless of a patient's ability to pay for health care. The Network Prior Authorization and Referral Specialist is responsible for the coordination of prior ... of reimbursement to physicians, nurses, financial clearance staff, and patients prior to services being rendered. JOB DUTIES AND RESPONSIBILITIES: + Obtains… more
- Henry Ford Health System (Troy, MI)
- RN REFERRAL MANAGEMENT COORDINATOR (VIRTUAL) - PRIOR AUTHORIZATIONS - 40 HOURS - DAY SHIFT Full Time Benefit Eligible Schedule: Monday through Friday, 8:00AM to ... Health Alliance Plan (HAP) is looking to grow our Prior Authorization Team with experienced Registered Nurses! We are...the time of the denial and distributes to the Utilization Management Services staff for processing. + Reports on… more
- Centene Corporation (New York, NY)
- …an active New York State nursing License.** **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service and appropriate ... teams, to assess medical necessity of care of member + Escalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of… more