• Clinical Review Nurse - Prior

    Actalent (West Des Moines, IA)
    Prior Authorization Nurse Job...State Licensure required. + For Health Net of California: RN license required. + For Superior Health Plan: ... Description This role involves analyzing prior authorization requests to determine the medical necessity of services...assess the medical necessity of member care. + Escalate prior authorization requests to Medical Directors as… more
    Actalent (11/11/25)
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  • Clinical Review Nurse - Prior

    Centene Corporation (New York, NY)
    …**License/Certification:** + LPN - Licensed Practical Nurse - State Licensure required + RN - Registered Nurse - State Licensure preferred Pay Range: ... **Must have a New York State nursing license.** **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service and… more
    Centene Corporation (11/15/25)
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  • Prior Authorization Specialist…

    Select Medical (West Orange, NJ)
    …- West Orange** A Select Medical Hospital West Orange, NJ ** Prior Authorization Specialist/ Payor Relations Specialist ( RN , LPN )** **Full-Time** **Onsite ... and independent judgment, the Payor Relations Specialist manages the pre-certification and prior authorization of referrals scheduled for admission to the Acute… more
    Select Medical (08/23/25)
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  • Oncology Prior Authorization Case…

    University of Miami (Miami, FL)
    …CORE FUNCTIONS: + Adhere and perform timely prospective review for services requiring prior authorization as well as timely concurrent review for continuation of ... initial, concurrent and retrospective chart reviews for clinical utilization and authorization . The Utilization Review Case Manager coordinates with the healthcare… more
    University of Miami (10/18/25)
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  • Care Review Clinician ( RN ) Prior

    Molina Healthcare (Dallas, TX)
    …TX licensed RN with Utilization Management experience to join our Prior Authorization reviewing team. Previous UM experience with MCG/Interqual guidelines as ... , managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted… more
    Molina Healthcare (10/29/25)
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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 (10/03/25)
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  • Care Review Clinician, Prior

    Molina Healthcare (MS)
    …**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 (09/06/25)
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  • Certified Medical Assistant - Prior

    Ascension Health (Indianapolis, IN)
    **Details** + **Department:** Prior Authorization + **Schedule:** Monday - Friday 8am - 4:30pm or 8:30am - 5pm (either schedule available), would also be open to ... + Assist with treatments ordered by provider as supervised by provider or registered nurse . Perform select clinical duties. + Interview patients, measure vital… more
    Ascension Health (09/30/25)
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  • Utilization Management Nurse Consultant…

    CVS Health (Harrisburg, PA)
    …with Microsoft Office Applications (Outlook, Teams, Excel) **Preferred Qualifications** Prior authorization utilization experience preferred Outpatient Clinical ... positions hours will be M-F with Weekend/Holiday Rotation._ **UM Nurse Consultant** Fully Remote- WFH **Position Summary** UM ...function. **Required Qualifications** 3+ years of experience as an RN Active and unrestricted RN licensure in… more
    CVS Health (11/15/25)
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  • Registered Nurse ( RN

    Walgreens (Deerfield, IL)
    …for customers, patients, team members and communities. **Job ID:** 1655228BR **Title:** Registered Nurse ( RN ) Specialty **Company Indicator:** Walgreens ... diagnoses and other clinical criteria to complete requests for prior authorization , specialty care specific to the...Associate's degree in Nursing + Current license/registration as an RN ( Registered Nurse ) with the… more
    Walgreens (10/03/25)
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