- CVS Health (Oklahoma City, OK)
- …in a dynamic, fast-paced setting **Preferred Qualifications** + Experience in ** utilization management** , **precertification** , or ** prior authorization** + ... to improving the quality and effectiveness of healthcare services and benefit utilization . This position requires close review of both handwritten and digital… 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
- CVS Health (Annapolis, MD)
- …5 years of relevant experience in Nursing. + At least 1 year of Utilization Management experience in concurrent review or prior authorization. + Strong ... that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. **Key… more
- CVS Health (Santa Fe, NM)
- …partial hospitalization and intensive outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or prior authorization. + ... for members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team....+ Experience in a high-volume clinical call center or prior remote work environment. **Education** + Associate's degree in… more
- US Tech Solutions (LA)
- …a hospital setting in a specialty area of the nursing field providing utilization management prior authorization reviews. Build strong direct relationships with ... + Minimum 3 years nursing experience with a minimum of 1 year in utilization management/ prior authorization review experience. **Experience** : Utilization … more
- Molina Healthcare (North Las Vegas, NV)
- …performing one or more of the following activities: care review/ utilization management ( prior authorizations, inpatient/outpatient medical necessity, etc.), ... Collates and reports on Care Access and Monitoring statistics including plan utilization , staff productivity, cost effective utilization of services, management… more
- Henry Ford Health System (Troy, MI)
- …REQUIRED: + Registered Nurse (RN) with current Michigan licensure. PREFERRED EXPERIENCE: + Prior Utilization review experience in a health insurance setting. + ... a team of Registered Nurses (3 and counting) and Utilization Review Coordinators (4) that review appeals for medical...with our Medical Directors. If you have experience with prior authorizations, are known for your attention to detail,… more
- Brockton Hospital (Brockton, MA)
- …management experience Proven experience in coordinating discharge planning and utilization review experience required. Prior management experience required. ... and effective delivery of patient care services through the appropriate utilization of healthcare resources. Participates in daily care rounds to collaborate… more
- Evolent (Atlanta, GA)
- …stakeholders. + Deep understanding of healthcare claims, reimbursement methodologies, and cost/ utilization KPIs, including prior authorisation data and key ... visualization, this role will collaborate cross-functionally to influence the effective utilization of data to deliver actionable insights, drive recommendations and… more
- Evolent (Helena, MT)
- …and stakeholders. + Familiarity with healthcare claims, reimbursement methodologies, and cost/ utilization KPIs, including prior authorization data and key ... : Analyze healthcare claims and authorization data to identify cost drivers, utilization trends, and population health opportunities using SAS, SQL, Excel, and Power… more