- Actalent (Rancho Cordova, CA)
- Job Title: Prior Authorization Nurse Job Description The Prior Authorization Nurse will triage and review cases as necessary, handling prior ... Responsibilities + Triage and review cases as needed. + Work on prior authorization cases following medical policy. + Utilize resources effectively to manage… more
- 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
- LA Care Health Plan (Los Angeles, CA)
- …regulatory requirements. + Knowledge of Coordination of Care, Medicare and Medi-Cal regulations, prior authorization , level of care and length of stay criteria ... Registered Nurse (RN) Manager, Appeals and Grievances General Operations...verbal, written communication and presentation skills. Licenses/Certifications Required Registered Nurse (RN) - Active, current and unrestricted California License… more
- UCLA Health (Santa Monica, CA)
- …issues that arise following procedures and surgeries, address prescription-related issues such as prior authorization , and carry out related tasks for the Center ... pain, is looking to fill the role of a Nurse Practitioner (NP). The NP is expected to provide...CURES-required + BLS Certification from ARC or AHA-required + Prior Urology experience -strongly preferred + Ability to utilize… more
- University of Southern California (Pasadena, CA)
- …provider in EMR ensuring 7 rights of medication safety. Initiates and completes prior authorization requests for medication as needed. Assists with diagnostic ... The Licensed Vocational Nurse (LVN) is an individual with specific knowledge and...authorization requests and same day insurance verification as needed. Escorts… more
- University of Southern California (Los Angeles, CA)
- The Coordinator/Navigator position is a Registered Nurse with recognized leadership abilities and sound clinical skills who will actively assist the physician in the ... responsibilities outlined below.The cancer coordinator/navigator is a professional Registered Nurse with oncology specific clinical knowledge who a) participates in… more
- Sharp HealthCare (La Mesa, CA)
- …referrals for care and services are directed to appropriate network providers, and obtains prior authorization for in network and out of network services as ... Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse (RN) - CA Board of Registered Nursing **Hours** **:** **Shift Start… more
- Sharp HealthCare (San Diego, CA)
- …referrals for care and services are directed to appropriate network providers, and obtains prior authorization for in network and out of network services as ... Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse (RN) - CA Board of Registered Nursing; Accredited Case Manager (ACM)… more
- Elevance Health (Walnut Creek, CA)
- …Management Representative I** is responsible for coordinating cases for precertification and prior authorization review. **How you will make an impact:** + ... eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization , and post service requests. + Refers cases… more
- Centene Corporation (Sacramento, CA)
- …a fresh perspective on workplace flexibility. **Position Purpose:** Supervises Prior Authorization , Concurrent Review, and/or Retrospective Review Clinical ... communication between utilization management team, members, and providers + Monitors prior authorization , concurrent review, and/or retrospective clinical review… more