- Humana (Madison, WI)
- …specifically Word, Excel, and Outlook. + At least 3-years experience with prior authorization / utilization management. **Preferred Qualifications** + ... and help us put health first** The UM/PA Nurse Supervisor plays a key leadership role in overseeing the...leadership role in overseeing the daily operations of the Utilization Management and Pre- Authorization nursing teams. This… more
- Texas A&M University System (College Station, TX)
- Job Title Registered Nurse II - Prior Authorization & Referral Agency Texas A&M University Health Science Center Department University Health Services Proposed ... health care delivery. What we want The Registered Nurse II- Prior Authorization and Referral, under general supervision,...experience in at least one of the following areas: Prior authorizations or utilization management , c… more
- Actalent (Sunrise, FL)
- …direct utilization and capture data effectively. Responsibilities + Review prior authorization requests for medical necessity and appropriateness, utilizing ... a liaison between the Medical Director, physicians, and office staff, resolving prior authorization issues. + Communicate denial determinations to providers when… more
- Commonwealth Care Alliance (Boston, MA)
- …Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical areas, including but ... 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager...Knowledge, Skills & Abilities (must have):** + Experience with prior authorization and retrospective reviews + Proficiency… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …advocate between Dana Farber Cancer Institute and various health plans. Reporting to the Prior Authorization Supervisor , the Clinical Authorization ... be overturned. + Appropriately escalates complex cases to Drug Authorization Supervisor or Manager of Prior...year of clinical and/or related experience required. Case Management, Utilization Review and/or Prior Authorization … more
- AmeriHealth Caritas (LA)
- …clinical experience in home healthcare or a medical office setting. + Previous prior authorization experience is required.; + Proficiency in Electronic Medical ... **Responsibilities:** Under the direction of a supervisor , the Clinical Care Reviewer - Utilization...a supervisor , the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient… more
- Dignity Health (Rancho Cordova, CA)
- …and the appropriate application of policies and guidelines to Managed Care prior authorization referral requests. Under general supervision this position is ... Summary:** Under the guidance and supervision of the department Manager/Director the Supervisor of Utilization Management is responsible and accountable for… more
- ChenMed (Winter Park, FL)
- …rapidly expanding and we need great people to join our team. The Supervisor , Intensive Community Care, RN is a multi-market leadership position responsible for ... guidance to their team. Directly reporting to the Manager of ICC, this Supervisor is responsible for their teams members assigned patient case load whose role… more
- ASM Global (Houston, TX)
- …north dock at NRG Stadium and NRG Center. + Ensuring all shipments received have prior authorization and verifying with the tenant any shipmentswithout prior ... has an excellent and immediate opening for a Dock Supervisor at NRG Park in Houston, Texas. NRG Park...Standards, applicable local codes and NFL's Best Practices. + Utilization of a variety of technological software, platforms, and… more
- Molina Healthcare (Savannah, GA)
- …this family include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns ... and comply with CMS guidelines. These staff may also be involved in providing utilization management/ prior authorization services as needed. * Supervises the… more
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