- UCLA Health (Los Angeles, CA)
- …is responsible for reviewing and evaluating clinical documentation related to prior authorization requests for medical services. The UM Review Nurse ... Description At UCLA Health, the Utilization Management ( UM ) Review Nurse plays a vital...of resources. Key Responsibilities: + Conducts clinical reviews of prior authorization requests to evaluate medical necessity… more
- Molina Healthcare (Boston, MA)
- …* At least 2 years experience, including experience in hospital acute care, inpatient review , prior authorization , managed care, or equivalent combination of ... a candidate with a MA RN licensure. Candidates with UM Medical Review background and experience using...requested treatments and/or procedures. * Conducts reviews to determine prior authorization /financial responsibility for Molina and its… more
- Humana (Schaumburg, IL)
- …and/or experience with medical terminology and/or ICD-10 codes. + Experience with Utilization Review and/or Prior Authorization , preferably within a managed ... Outlook **Preferred Qualifications** + A minimum of an Associate's degree. + Prior billing/claims or authorization experience + Proficient utilizing electronic… more
- Molina Healthcare (Orlando, FL)
- …family include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... clinical pharmacy services (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight (establishing… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …UM Coordinator is responsible for coordinating all aspects of the prior authorization process, including member eligibility and benefit verification, ... members of the organization. Primary Responsibilities + Research and confirm authorization requirements and communicate to member, providers, and facility staff. +… more
- CVS Health (AZ)
- …of 1 year of experience in Oncology and Transplant either in UM , concurrent review , or prior authorization + 3+ years of experience in Acute clinical ... the lives of patients facing complex medical journeys. As a Utilization Management ( UM ) Nurse Consultant specializing in Oncology and Transplant, you'll play a vital… more
- Molina Healthcare (Vancouver, WA)
- …2 years health care experience, including experience in hospital acute care, inpatient review , prior authorization , managed care, or equivalent combination ... stay for requested treatments and/or procedures. * Conducts reviews to determine prior authorization /financial responsibility for Molina and its members. *… more
- Molina Healthcare (Layton, UT)
- …benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina ... + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. +...Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management… more
- Molina Healthcare (Southaven, MS)
- …benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina ... + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. +...teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional travel to other… more
- LA Care Health Plan (Los Angeles, CA)
- …Preferred: Experience in Medi-Cal managed care. 1 year of experience in UM / Prior Authorization . Skills Required: Demonstrated proficiency in Medical ... support the safety net required to achieve that purpose. Job Summary The Authorization Technician II supports the Utilization Management ( UM ) Specialist by… more
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