- 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
- 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
- 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
- Martin's Point Health Care (Portland, ME)
- …prevent or reduce hospital admissions where appropriate. Job Description 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
- US Tech Solutions (Chicago, IL)
- …as an RN + Registered Nurse in state of residence + Must have prior authorization utilization experience + Experience with Medcompass **Skills:** + MUST HAVE ... MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . +...knowledge of Milliman/MCG. + MUST HAVE 6 months of Prior Authorization . **Education:** + Active and unrestricted… more
- Molina Healthcare (North Las Vegas, NV)
- …* At least 2 years experience, including experience in hospital acute care, inpatient review , prior authorization , managed care, or equivalent combination of ... stay for requested treatments and/or procedures. * Conducts reviews to determine prior authorization /financial responsibility for Molina and its members. *… more
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