- Humana (Albany, NY)
- …part of our caring community and help us put health first** Humana is seeking a Prior Authorization RN to join the Wisconsin Medicaid Market (iCare) team. ... This position reviews the clinical appropriateness of prior authorization (PA) requests and ensures that...make an impact** **Required Qualifications** + Licensed as a Registered Nurse in the State of Wisconsin,… more
- Molina Healthcare (Buffalo, NY)
- For this position we are seeking a ( RN ) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity ... , managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted… more
- Molina Healthcare (Yonkers, NY)
- …, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... stay for requested treatments and/or procedures. * Conducts reviews to determine prior authorization /financial responsibility for Molina and its members. *… more
- The New Jewish Home (Manhattan, NY)
- …admission coverage as needed. 11. Performs other duties as required. JOB QUALIFICATIONS: 1. Registered Nurse in the State of New York. 2. MDS experience and ... obtain pre- authorization ; reviews level requirements to obtain appropriate level prior to admissions. 8. Conducts tours of the facilities with potential… more
- Trinity Health (Albany, NY)
- …electronically and send prescriptions to providers for review and submission. + Obtains prior authorization for diagnostic testing and medication and enters into ... **Employment Type:** Full time **Shift:** Day Shift **Description:** ** RN Clinical Lead - Albany Internal Medicine** If...the practice of the profession of nursing as a registered professional nurse is defined as diagnosing… more
- Crouse Hospital (Syracuse, NY)
- …the health care system from the initiation of the referral, to obtaining prior authorization , scheduling appointments and tracking and following up on results. ... Required Qualifications: Registered Nurse , Demonstrated experience in a multi-specialty physician office. Excellent customer service skills. Excellent computer… more
- Stony Brook University (Stony Brook, NY)
- …with the transferring hospital, Patient Access and physicians and payers for authorization prior to transfer from other hospitals. + Consistent documentation ... of care from initial assess point. Follows cases for authorization for in patient stay. + Staff review short...required. **Qualifications** **Required** : A Bachelor's degree or a nurse working on their degree with an RN… more
- Centene Corporation (New York, NY)
- …Provides first level RN review for all outpatient and ancillary prior authorization requests for medical appropriateness and medical necessity using ... NYS Driver's License or Identification card.** **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for all outpatient and… more
- Healthfirst (NY)
- …oversight and operational management for all utilization management functions, including prior authorization , concurrent review, and service requests Lead, ... coach, and develop UM managers overseeing interdisciplinary teams of registered nurses, social workers, clinicians, and coordinators Ensure UM operations meet… more
- Guthrie (Binghamton, NY)
- …safe and timely dispensing of the medication for the patient as needed. Medication Prior Authorization + Collect necessary documentation and submit it to the ... needed for patient that have arrived without orders. Prepare educational materials for the RN Nurse Navigator for Chemo Education Visits per the instruction and… more