- Elevance Health (San Antonio, TX)
- …and personalized support throughout the consumer's treatment journey. **Title:** Utilization Management Representative II - Prior Authorization **Location:** ... Health location. **Build the Possibilities. Make an extraordinary impact.** The Utilization Management Representative II - Prior Authorization is responsible… more
- Sanford Health (SD)
- …regarding trends, external regulations and internal policies that effect resource utilization and potentially, prior authorization. Assists the department in ... level of care medical necessity reviews within patient's medical records. Performs utilization management (UM) activities in accordance with UM plan to assure… more
- Centene Corporation (Jefferson City, MO)
- …members. **Position Purpose:** Oversee operations of the referral management, telephonic utilization review, prior authorization, and various related functions ... compliance with National Committee for Quality Assurance (NCQA) standards for utilization management functions, prior authorization and concurrent review units… more
- Cleveland Clinic (Cleveland, OH)
- …for the ideal future caregiver include: + Case Management Certification (CCM) + Prior Utilization Management experience Our caregivers continue to create the ... most respected healthcare organizations in the world. As a Utilization Management Specialist, you will perform UM activities, such...who excels in this role will: + Recommend resource utilization . + Prioritizes and organizes work to meet changing… more
- Queen's Health System (Honolulu, HI)
- …Emma Clinics (QEC). * Performs duties and responsibilities in accordance with utilization tracking and prior authorization procedures. * Assists with ... RESPONSIBILITIES I. JOB SUMMARY/RESPONSIBILITIES: * Coordinates and maintains the utilization review process for clinical services including medical, surgical and… more
- Centene Corporation (Jefferson City, MO)
- …as outlined by the applicable state required. Knowledge of BH utilization management principles preferred. Prior supervisory experience preferred preferred. ... on workplace flexibility. **Position Purpose:** Supervises the behavioral health (BH) utilization review clinicians to ensure appropriate care for members and… more
- US Tech Solutions (Chicago, IL)
- …as an RN + Registered Nurse in state of residence + Must have prior authorization utilization experience + Experience with Medcompass **Skills:** + MUST HAVE ... and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review. + MUST HAVE 1 YEAR OF...Prior Authorization? + Do you have experience with Utilization Review? + Do you have an Active Registered… more
- Humana (Raleigh, NC)
- …2-3 years Skilled nursing facility experience and /or skilled nursing facility utilization management review experience. + Prior clinical experience preferably ... of our caring community and help us put health first** The Utilization Management Nurse utilizes clinical nursing skills to support the coordination, documentation… more
- US Tech Solutions (May, OK)
- …inpatient hospital experience . Registered Nurse in state of residence . Must have prior authorization utilization experience . Able to work in multiple IT ... and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review. . MUST HAVE 1 YEAR OF...knowledge of Milliman/MCG. . MUST HAVE 6 months of Prior Authorization. Education: . Active and unrestricted RN licensure… more
- Sanford Health (WI)
- …**Weekly Hours:** 40.00 **Salary Range:** $21.50 - $28.00 **Job Summary** Monitors the utilization of resources, risk management and quality of care for patients in ... accordance to established guidelines and criteria for designated setting and status. Collection of clinical information necessary to initiate commercial payor authorization. Obtain and maintain appropriate documentation concerning services in accordance to… more
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