• Clinical Review Nurse - Prior

    Actalent (Ridgeland, MS)
    …of utilization management processes. Additional Skills & Qualifications + Registered Nurse ( RN ) preferred. + Prior experience with clinical review ... Job Title: Prior Authorization NurseJob Description The Prior Authorization Nurse plays a crucial role in analyzing authorization requests to… more
    Actalent (05/01/25)
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  • RN Clinical Review Nurse

    Centene Corporation (New York, NY)
    …must possess NY RN State Licensure **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service and appropriate ... interdepartmental teams, to assess medical necessity of care of member + Escalates prior authorization requests to Medical Directors as appropriate to determine… more
    Centene Corporation (05/03/25)
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  • Utilization Management Specialist (Home-Based)…

    Sanford Health (SD)
    …for Nursing Commission for Nursing Education Accreditation (NLN CNEA). Currently holds an unencumbered registered nurse ( RN ) license with the State Board of ... relating to the implementation, ongoing evaluation, and improvements to UM and/or prior authorization processes with applicable. Completes activities relating to… more
    Sanford Health (04/30/25)
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  • Care Review Clinician, Prior

    Molina Healthcare (Las Cruces, NM)
    …**JOB QUALIFICATIONS** **Required Education** Any of the following: Completion of an accredited Registered Nurse ( RN ), Licensed Vocational Nurse (LVN) ... medical clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ), Licensed Vocational Nurse more
    Molina Healthcare (04/30/25)
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  • Care Review Clinician, Prior

    Molina Healthcare (Seattle, WA)
    …**JOB QUALIFICATIONS** **Required Education** Any of the following: Completion of an accredited Registered Nurse ( RN ), Licensed Vocational Nurse (LVN) ... medical clinic experience. **Required License, Certification, Association** Active, unrestricted State Registered Nursing ( RN ), Licensed Vocational Nurse more
    Molina Healthcare (04/11/25)
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  • UM Prior Authorization Review…

    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 ... efficient utilization of resources. Key Responsibilities: + Conducts clinical reviews of prior authorization requests to evaluate medical necessity and benefit… more
    UCLA Health (04/22/25)
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  • LPN - Prior Authorization

    Ascension Health (Wichita, KS)
    **Details** + **Department: Prior Authorization Radiology/Radiation Oncology** + **Schedule: M-F 8am-5pm** + **Clinic: Ascension Medical Group** + **Location: ... the offer._ **Responsibilities** Provide care to patients under the direction of a registered nurse or physician, functioning within scope of license. +… more
    Ascension Health (03/27/25)
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  • Medical Assistant and Prior

    Intermountain Health (Murray, UT)
    …discretion after training and proficiency demonstrated. This is for an MA prior authorization specialist for the Neurosciences Institute. The caregiver will ... Medical Assistant experience (verified upon hire) + Or current RN /LPN license to practice nursing in the state +...Support Certification (BLS) for healthcare providers. Must be obtained prior to start date + Demonstrated basic computer skills… more
    Intermountain Health (04/22/25)
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  • Pre- Authorization Registered

    Humana (Atlanta, GA)
    …looking for an internship that supports the goal to put health first? The Prior Authorization , Registered Nurse , RN , Intern will review prior ... of professional onsite, field, or remote based opportunities. The Prior Authorization , Registered Nurse , RN , Intern will utilize Humana's Medicaid… more
    Humana (04/30/25)
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  • RN Supervisor UM Prior Auth

    Dignity Health (Rancho Cordova, CA)
    …skills. - Graduate of an accredited school of nursing. - Clear and current CA Registered Nurse ( RN ) license. **Preferred Qualifications:** - 7 years UM ... and the appropriate application of policies and guidelines to Managed Care prior authorization referral requests. Under general supervision this position is… more
    Dignity Health (04/17/25)
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