- CVS Health (Raleigh, NC)
- …5:30pm EST with occasional holiday rotation. **Preferred Qualifications** + Prior Authorization or Utilization Management experience + Managed care ... all with heart, each and every day. **Position Summary** Medicare Precertification Utilization Management Nurse Consultant position: _Utilization Management … more
- CVS Health (Austin, TX)
- …Office applications (Outlook, Teams, Excel) **Preferred Qualifications** + Prior authorization or Utilization Management experience + Managed care ... internal and external constituents in the coordination and administration of the utilization /benefit management function. **_Please note: This is a full time… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- … Utilization Management services to its clients. The Utilization Management Nurse - Prior Authorization performs medical necessity reviews on ... prior authorization requests in accordance with national standards, contractual requirements,...coverage while working remotely. Primary Responsibilities * Perform prospective utilization reviews and first level determinations for members using… more
- Actalent (Columbus, OH)
- …+ Comply with all organizational policies and standards. Essential Skills + Utilization management + Prior authorization + Utilization review + ... Authorization Specialist *REMOTE & MUST LIVE IN OHIO*...NCQA, Medicare and Medicaid regulations preferred + Knowledge of utilization management processes preferred + LPN -… more
- Elevance Health (Woodbridge, NJ)
- …assess provider satisfaction. Assessment shall include provider experiences with claims processing, prior authorization , utilization management , and ... **Clinical Quality Management Analyst Sr. Behavioral Health** **Location:** 111 Wood...(HCQM) by the American Board of Quality Assurance and Utilization Review Physicians. **Preferred Skills, Capabilities & Experiences:** +… more
- Humana (Madison, WI)
- …other relevant parties to coordinate care and resolve complex issues. + Lead the Prior Authorization / Utilization Management , Medicaid Care Management ... the ability to obtain quickly) + At least 8 years of experience in Prior Authorization / Utilization Management , Medicaid Care Management , and/or Nurse… more
- Centene Corporation (Olympia, WA)
- …health programs such as mental health parity, community services overutilization, prior authorization , and utilization management reform. + Serve as the ... as mental health parity, community services overutilization, prior authorization , and utilization management reform. + Analyze data related to behavioral… more
- Centene Corporation (Olympia, WA)
- …health programs such as mental health parity, community services overutilization, prior authorization , and utilization management reform. + Serve as the ... as mental health parity, community services overutilization, prior authorization , and utilization management reform. + Analyze data related to behavioral… more
- Centene Corporation (Jefferson City, MO)
- …**Position Purpose:** Oversee operations of the referral management , telephonic utilization review, prior authorization , and various related functions ... Committee for Quality Assurance (NCQA) standards for utilization management functions, prior authorization and concurrent review units + Collaborate with… more
- Humana (Muncie, IN)
- …+ Ensures the transfer and receipt of all outstanding prior authorization decisions, utilization management data, and clinical information such ... as prevention and wellness programs(s), care management and complex case management notes. +... Certification (CCM) + Interqual or Millman experience + Prior experience with Medicare & Medicaid recipients + Previous… more
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