- Elevance Health (San Antonio, TX)
- …consumer's treatment journey. **Title:** Utilization Management Representative II - Prior Authorization **Location:** Onsite at 4751 Hamilton Wolf Rd, STE ... impact.** The Utilization Management Representative II - Prior Authorization is responsible for managing incoming...caller. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. +… more
- Sanford Health (SD)
- …team regarding trends, external regulations and internal policies that effect resource utilization and potentially, prior authorization . Assists the ... relating to the implementation, ongoing evaluation, and improvements to UM and/or prior authorization processes with applicable. Completes activities relating to… more
- Sanford Health (WI)
- …**Weekly Hours:** 40.00 **Salary Range:** $21.50 - $28.00 **Job Summary** Monitors the utilization of resources, risk management and quality of care for patients in ... Collection of clinical information necessary to initiate commercial payor authorization . Obtain and maintain appropriate documentation concerning services in… more
- Actalent (Ridgeland, MS)
- Job Title: Prior Authorization NurseJob Description The Prior Authorization Nurse plays a crucial role in analyzing authorization requests to ... the quality and cost-effectiveness of medical care. Responsibilities + Analyze prior authorization requests to determine medical necessity and appropriate… more
- Centene Corporation (Tallahassee, FL)
- …SUPPORTING MEDICARE UTILIZATION FOR OUTPATIENT, DME, HOME HEALTH AND MEDICAL PRIOR AUTHORIZATION APPROVALS.** **THE WORK SCHEDULE WILL BE MONDAY - FRIDAY ... SATURDAY OR SUNDAY WITH A WEEK DAY OFF.** **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service and… more
- Molina Healthcare (Seattle, WA)
- …benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina ... + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. +...Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization… more
- UCLA Health (Los Angeles, CA)
- …This position is responsible for reviewing and evaluating clinical documentation related to prior authorization requests for medical services. The UM Review ... Description At UCLA Health, the Utilization Management (UM) Review Nurse plays...of resources. Key Responsibilities: + Conducts clinical reviews of prior authorization requests to evaluate medical necessity… more
- The Arora Group (Bethesda, MD)
- Licensed Practical Nurse (LPN) - Utilization Review Nurse Currently recruiting a Licensed Practical Nurse (LPN/LVN) - Utilization Review in Bethesda, ... Services will be required on Federal holidays. DUTIES OF THE LICENSED PRACTICAL NURSE (LPN/LVN) - UTILIZATION REVIEW: + Initiate, perform and complete assigned… 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 ... + Do you have experience with Prior Authorization ? + Do you have experience with Utilization... Review? + Do you have an Active Registered Nurse License? **About US Tech Solutions:** US Tech Solutions… more
- CDPHP (Albany, NY)
- …responsible for the clinical review and documentation for services requiring prior authorization . This includes approval determinations and appropriate ... of acute care experience is required as a Registered Nurse . + Minimum of two (2) years Utilization... Nurse . + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of coding/claims… more
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