- US Tech Solutions (May, OK)
- …+ 1-3 years of related work experience (healthcare or call center preferred). + Prior experience with utilization management or prior authorization processes ... UM Nurse Associate I is responsible for reviewing and completing criteria-based prior authorizations in compliance with company policies and procedures. This role… more
- ManpowerGroup (Austin, TX)
- …services in Texas. This is a non-clinical, **remote** -review role focused on ** prior authorization** and ** utilization management** -ideal for RNs who thrive in ... license in good standing. * Strong clinical judgment and understanding of utilization review processes. * Excellent communication and documentation skills. * Ability… more
- Molina Healthcare (Covington, KY)
- …state health plan's Healthcare Services (clinical operations) teams including Utilization Management ( prior -authorization, inpatient review) and Care Management ... unrestricted State Registered Nursing (RN) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care Quality… more
- Humana (Springfield, IL)
- …member service or customer service telephone experience desired + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care ... The UM Administration Coordinator 1 contributes to administration of utilization management. The UM Administration Coordinator 1 performs basic… more
- CVS Health (Springfield, IL)
- …concurrent review, and appeal request. This position is primarily responsible for Utilization Management, including prior authorization as well as concurrent ... the Aetna Better Health Plan of Illinois. This UM ( Utilization Management) Medical Director will be a "Work from...Medicine, General Surgery or Internal Medicine / Pediatrics - Prior UM experience working at Health Plan / Insurer… more
- Elevance Health (Washington, DC)
- …regulatory and accreditation, compliance and quality management. + Must have prior utilization management leadership experience For candidates working in ... and acuity. + Provides direct oversight and is responsible for Utilization Management execution/decision making for managed member populations. Primary duties may… more
- Dignity Health (Bakersfield, CA)
- …to patient information, PHI and HIPAA regulations. **Preferred Qualifications:** - Prior Utilization Management (UM) experience strongly preferred. - Bachelor's ... as part of the regular schedule for this position.** **Position Summary:** The Utilization Management LVN is responsible for ensuring the integrity of the adverse… more
- CenterWell (Cheyenne, WY)
- …& Reporting: Define and track KPIs related to referral throughput, network utilization , and prior authorization efficiency; use data to drive continuous ... execution for our referral management and specialist network solutions, including prior authorization and related EMR-integrated capabilities. This role is critical… more
- Optimax Systems, Inc (Ontario, NY)
- …accomplishing related results as needed. Through On the Job Training (OJT) and utilization of prior experience, the Process Engineer will: + Evaluate ... and testing experience or ten (15) years industrial manufacturing experience desired + Prior experience in the production of precision optics desired + Prior … more
- Centene Corporation (Sacramento, CA)
- …on workplace flexibility. **RN highly preferred** **Remote opportunity** **Role is supporting Prior Authorization team working in PST- experience with prior auth ... is highly preferred** **Position Purpose:** Directs the utilization management team to ensure the appropriate application of policy procedures and processes to help… more