- 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
- Humana (Austin, TX)
- …new systems (proficient to advanced) **Preferred Qualifications** + Experience with Utilization Review and/or Prior Authorization , preferably within a ... caring community and help us put health first** The UM Administration Coordinator provides clerical support for the department....the nursing team + Builds and pends authorizations for review + Responsible for inbound and outbound calls to… more
- Healthfirst (NY)
- …oversight and operational management for all utilization management functions, including prior authorization , concurrent review , and service requests** ... institution or equivalent work experience** **NYS RN** **Demonstrated understanding of UM regulatory requirements, clinical review process, and managed care… more
- Humana (Bismarck, ND)
- …utilizing electronic medical record and documentation programs + Experience with Utilization Review and/or Prior Authorization , preferably within a managed ... + Knowledge of Medical Terminology and/or ICD-10 codes + Experience with Utilization Review and/or Prior Authorization , preferably within a managed care… more
- Centene Corporation (Des Moines, IA)
- …to target unique populations. + Oversees performance of all UM functions ( prior authorization , concurrent review ) for the market per the defined ... partnership agreement + Orchestrates all elements of the population health strategy for the business + Drives HBR initiatives locally through strong partnership and routine with + Partners with MDs to translate the needs of the members into intentional… more
- Sharp HealthCare (San Diego, CA)
- …Room, Physician offices, or home coordinating with the SNF admission liaison for authorization of level of care as appropriate.Assists with transfers to SNF of ... business day and assigns an LOS based on MCG, prior level of function, comorbidities, and discharge goals. Rounds...of any quality issues. + Chart reviewPerforms a comprehensive review of medical history, doctor's orders, progress notes, therapy… more
- Molina Healthcare (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
- Highmark Health (Monroeville, PA)
- …administration of effective and efficient processing for pharmacy benefits prior authorization processes, insurance evaluations, addressing patient medication ... medication reconciliation, and overseeing referral screening/management. **ESSENTIAL RESPONSIBILITIES** + Prior Authorization & Utilization Management: Reviews pharmacy… more
- Molina Healthcare (Albany, NY)
- …* At least 2 years experience, including experience in hospital acute care, inpatient review , prior authorization , managed care, or equivalent combination of ... JOB DESCRIPTION **Job Summary** The Care Review Clinician RN provides support for clinical member...requested treatments and/or procedures. * Conducts reviews to determine prior authorization /financial responsibility for Molina and its… more
- Integra Partners (Troy, MI)
- …with administrative and non-clinical tasks related to processing Utilization Management prior authorization sand appeals. JOB RESPONSIBILITIES + Monitor incoming ... faxes + Enter UM authorizations review requests in ...+ Verify all necessary documentation has been submitted with authorization requests + Contact requesting providers to obtain medical… more
Recent Jobs
-
Production Maintenance Technician
- Amentum (Sanford, NC)
-
Process Development and Scale - Up Engineer
- ExxonMobil (Houston, TX)
-
Clinical Polysomnographic Technician
- UHS (Binghamton, NY)