- Actalent (Sunrise, FL)
- Actalent is Hiring Multiple Remote HEDIS RN Abstractor Description: Position Purpose: Lead data collection and abstraction for company quality measures, including ... HEDIS, CMS, CHIPRA and/or any other custom measurements. Responsibilities: + Assess vendor-delegated abstraction activities and compare results to HEDIS standards and/or custom or other measure set standards + Review medical records and abstract data for HEDIS… more
- Martin's Point Health Care (Portland, ME)
- …hospital admissions where appropriate.Utilization Review Nurse Key Outcomes: + Review prior authorization requests ( prior authorization , ... a need for inpatient/ outpatient authorizations. This position receives and reviews prior authorization requests for specific inpatient and outpatient medical… more
- Centene Corporation (Atlanta, GA)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Supervises Prior Authorization , Concurrent Review, and/or Retrospective Review ... communication between utilization management team, members, and providers + Monitors prior authorization , concurrent review, and/or retrospective clinical… more
- Commonwealth Care Alliance (Boston, MA)
- …Abilities (must have): * Expertise in managing utilization review processes including prior authorization , concurrent and retrospective reviews * ... Director of Utilization Management * Oversees clinical decision review for services requiring prior authorization in a variety of clinical areas, including but… more
- Independent Health (Buffalo, NY)
- …Degree in Nursing required; Bachelor's degree preferred. Current, active, unrestricted, and licensed registered nurse ( RN ) required. + Two (2) years of ... High Quality, Professional Utilization Management Services: (Medical necessity review for prior authorization , pre-certification, concurrent , as well as… more
- Intermountain Health (Murray, UT)
- …and diagnosis to apply evidence-based guidelines (eg InterQual) and medical policies for prior authorization and concurrent reviews. + Follows the applicable ... + Resourceful + Verbal and Written Communication **Qualifications** Minimum Qualifications + Current RN ( Nurse ) compact license to practice in all states that… more
- Tenet Healthcare (Detroit, MI)
- Registered Nurse Case Manager Contingent Days - 2506001465 Description : DMC Harper University Hospital has distinguished itself in surgery and medicine and is ... hypertension, stroke prevention and heart failure. Job Description: The RN Case Manager is responsible to facilitate care along...management experience preferred. 3. License to practice as a Registered Nurse in the State of Michigan.… more
- Molina Healthcare (Naperville, IL)
- …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
- Banner Health (Phoenix, AZ)
- …met for our wholly owned and delegated plans in the areas of prior authorization , census management, prospective/ concurrent /retro review, and appeals. Care ... require applicable certifications and/or licensures, including but not limited to: RN ; MD or DO; Driver's License; Certified Healthcare Protection Administrator… more
- Access Dubuque (Dubuque, IA)
- …daily utilization functions for assigned patients, including prior authorization , admission, precertification/certification/recertification, concurrent ... SISCO RN -Inpatient Acute Rehab UnityPoint Health Finley Hospital Clinic RN - Registered Nurse : Oncology/ Palliative MercyOne Registered Nurse… more