- Humana (Baton Rouge, LA)
- …an acute or outpatient behavioral health setting + Experience with Utilization Management or Prior Authorization + Experience with behavioral change, ... part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional utilizes behavioral health knowledge and… more
- Actalent (Atlanta, GA)
- …has a background in utilization review nurse, or prior authorization nurse. Skills clinical review, case management , rn license, medical, claim Top ... LCD, NCD) . Utilization Review ( Prior Authorization ) Medicare experience ( Utilization Management with Medicare) ICU, Medical Surgical background ,… more
- US Tech Solutions (LA)
- …walls of a hospital setting in a specialty area of the nursing field providing utilization management prior authorization reviews. Build strong direct ... Minimum 3 years nursing experience with a minimum of 1 year in utilization management / prior authorization review experience. **Experience** : … more
- Actalent (Cincinnati, OH)
- …successful completion of cases. Essential Skills + Experience in utilization management , concurrent review, prior authorization , utilization review, ... planning. + Proficiency with InterQual. + Active Compact RN/LVN/LPN License. + Utilization Management /Concurrent Review experience. + ICU/ER experience. + Strong… more
- CaroMont Health (Gastonia, NC)
- …Summary: The Pre- Authorization Specialist is a member of the Utilization Review Department who is responsible for verifying eligibility, obtaining insurance ... benefits, and ensuring pre-certification, authorization , and referral requirements are met prior to the delivery of inpatient, outpatient, and ancillary… more
- Molina Healthcare (Tacoma, WA)
- …+ Oversees an integrated Care Access and Monitoring team responsible for prior authorizations and/or other utilization management activities aimed ... are seeking a candidate with a WA state LPN licensure. Candidates with previous prior authorization and MCO experience are highly preferred. Further details to… more
- Actalent (Eugene, OR)
- Job Title: Clinical Review Nurse - Prior Authorization Job Description This role involves analyzing all prior authorization requests to determine the ... the medical necessity of care for members. + Escalate prior authorization requests to Medical Directors as...Knowledge of Medicare and Medicaid regulations. + Knowledge of utilization management processes. Work Environment This position… more
- Actalent (Eugene, OR)
- …Review Nurse - Prior AuthorizationJob Description This role involves analyzing prior authorization requests to assess the medical necessity of services and ... to assess medical necessity for member care. + Escalate prior authorization requests to Medical Directors when...Knowledge of Medicare and Medicaid regulations + Familiarity with utilization management processes + True care experience… more
- Centene Corporation (Jefferson City, MO)
- …Role has weekend and holiday rotations. _** **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service and ... interdepartmental teams, to assess medical necessity of care of member + Escalates prior authorization requests to Medical Directors as appropriate to determine… more
- Sanford Health (SD)
- …Summary** The Patient Access Specialist reviews and validates insurance eligibility, prior authorization and/or referral of medication, procedures, etc.; ... determines if insurance meets prior authorization criteria. Collects necessary documentation and...in case management module; provides direction to utilization management , case management , and… more
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