- Actalent (Eugene, OR)
- Job Title: Clinical Review Nurse - Prior Authorization Job Description This role involves analyzing all prior authorization requests to determine the ... medical necessity of care for members. + Escalate prior authorization requests to Medical ... Nurse (RN) certification. + Clinical review and prior authorization experience. + 2-4 years of… more
- Actalent (Eugene, OR)
- …- Prior AuthorizationJob Description This role involves analyzing prior authorization requests to assess the medical necessity of services and the ... medical necessity for member care. + Escalate prior authorization requests to Medical ...Skills + Clinical review experience + Prior authorization expertise + Licensed Practical Nurse (LPN)… more
- US Tech Solutions (May, OK)
- …pharmacists, other clinical colleagues, healthcare professionals and members. + Follow all prior authorization procedures to guarantee an accurate process on ... following policy and procedure. + Provide on-call after hours nurse availability for urgent PA requests. + Provide internal...each prior authorization . + Train and mentor representatives… more
- Humana (Frankfort, KY)
- **Become a part of our caring community and help us put health first** The Pre- Authorization Nurse 2 reviews prior authorization requests for appropriate ... and independent determination of the appropriate courses of action. The Pre- Authorization Nurse 2 completes medical necessity and level of care… more
- Humana (Tallahassee, FL)
- …barriers to helping people achieve their best health. Humana CarePlus is seeking a Pre- Authorization Nurse who reviews prior authorization requests for ... and approves services or forward requests to the appropriate stakeholder. The Pre- Authorization Nurse roles and responsibilities include but are not limited… more
- LifePoint Health (Wilson, NC)
- …in a clinic setting, Gastro experience preferred . Knowledge of insurance policies, prior authorization procedures, and medical terminology. . Knowledge of ... *Licensed Practical Nurse (LPN), Pulmonary Clinic* Job Type: Full-Time, Days...insurance policies, prior authorization procedures, and medical terminology. . Strong… more
- Molina Healthcare (Tacoma, WA)
- …are seeking a candidate with a WA state LPN licensure. Candidates with previous prior authorization and MCO experience are highly preferred. Further details to ... with all state and federal regulations and guidelines. + Provides feedback on annual prior authorization policy changes. + Ensures prior authorization … more
- Molina Healthcare (Spokane, WA)
- …and its members. + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …+ Discusses complex medical necessity cases in all aspects of the prior authorization work (on-label drug, off-label drug, laboratory testing, and others as ... environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve as a liaison and… more
- Baptist Memorial (Memphis, TN)
- …strategy. Specifically the managed care techniques the Coordinator uses focuses on prior authorization for services using evidence based criteria. Areas of ... with Utilization Review Nurse + Works assigned queues in the electronic medical record + Documents next review dates in the electronic medical record… more
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