• 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 ... **Required Knowledge, Skills & Abilities (must have):** + Experience with prior authorization and retrospective reviews + Proficiency reviewing clinical/medical… more
    DirectEmployers Association (10/02/25)
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  • Commonwealth Care Alliance (Boston, MA)
    …Director of Utilization Management - Oversees clinical decision review for services requiring prior authorization in a variety of clinical areas, including but ... (must have): - Expertise in managing utilization review processes including prior authorization , concurrent and retrospective reviews - Demonstrated ability… more
    DirectEmployers Association (10/02/25)
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  • 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
    DirectEmployers Association (10/23/25)
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  • Commonwealth Care Alliance (Boston, MA)
    …of member appointments, transportation, translation, and interpretation services. - Initiates prior authorization intake process. - Assist in resolving member ... , health plan, insurance or government is preferred. - Prior experience working in the health care industry front...applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Alliance is an… more
    DirectEmployers Association (09/27/25)
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  • Luke Staffing (Yigo, GU)
    …+ **Licensure:** Current, full, active, and unrestricted license to practice as a Practical OR Registered Nurse in any one of the 50 States, the District of ... ** NURSE - REFERRAL MANAGEMENT** **SITE OF SERVICE:** +...+ Ensures Line of Duty paperwork is on file prior to authorization . + Verify eligibility of… more
    DirectEmployers Association (08/04/25)
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  • National Youth Advocate Program (Fairfax, VA)
    …auditing processes. + Performs other duties as requested. **MINIMUM QUALIFICATIONS** + Licensed Registered Nurse ( RN ) with a Bachelor's or Higher ... + Assist in obtaining medical clearances from healthcare providers. + Preparing Treatment Authorization Requests (TARs) prior to appointments and following up to… more
    DirectEmployers Association (10/18/25)
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  • Tidelands Health (Murrells Inlet, SC)
    …communication skills and ability to multi-task required. **Licenses and Certifications** + Registered Nurse - South Carolina Department of Labor, Licensing and ... Team Tidelands and help people live better lives through better health!** **Outpatient Nurse ( RN )** Are you passionate about quality and committed to excellence?… more
    DirectEmployers Association (10/23/25)
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  • Manager, Prior Authorization UM…

    CVS Health (Austin, TX)
    … authorization trends, turnaround times, and team performance. **Required Qualifications** + Registered Nurse ( RN ) with an active and unrestricted licene ... do it all with heart, each and every day. **Position Summary** The Manager of Prior Authorization oversees the daily operations of the prior authorization… more
    CVS Health (10/23/25)
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  • Clinical Review Nurse - Prior…

    Centene Corporation (New York, NY)
    …**License/Certification:** + LPN - Licensed Practical Nurse - State Licensure required + RN - Registered Nurse - State Licensure preferred Pay Range: ... **Must have a New York State nursing license.** **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service and… more
    Centene Corporation (10/05/25)
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  • Prior Authorization Specialist…

    Select Medical (West Orange, NJ)
    …- West Orange** A Select Medical Hospital West Orange, NJ ** Prior Authorization Specialist/ Payor Relations Specialist ( RN , LPN )** **Full-Time** **Onsite ... and independent judgment, the Payor Relations Specialist manages the pre-certification and prior authorization of referrals scheduled for admission to the Acute… more
    Select Medical (08/23/25)
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