- 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
- Dignity Health (Rancho Cordova, CA)
- …and the appropriate application of policies and guidelines to Managed Care prior authorization referral requests. Under general supervision this position is ... responsible for coordinating the daily operations of the UM Pre- Authorization team in order to ensure...review a referral. Fosters the relationship between the Pre- Authorization team and the Medical Director and Physician Reviewers.… more
- Fallon Health (Worcester, MA)
- …notifications, discharging Acute, Elective and Maternity authorizations within parameters of Fallon UM guidelines * Review post-acute authorization requests, ... data and disseminates information to the Utilization Nurses for review . Additionally, supports the authorization process by...create an authorization , and triage to the UM nurse as per productdelegation * Research claims in… more
- The Cigna Group (Morris Plains, NJ)
- …risks or barriers to policy criteria + Possess a working knowledge of formulary prior authorization , & coverage review determination processes and claims ... field. + In depth understanding of regulatory and compliance requirements for drug prior authorization at both state and federal level. + Familiarity with… 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
- Centene Corporation (Tallahassee, FL)
- …unique populations + **Leadership** + 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 Finance + Partners with MDs to translate the needs of the members into intentional… more
- Molina Healthcare (Syracuse, NY)
- …service. We are seeking a candidate with a New York RN licensure, UM and Prior Authorization experience. The Care Review Clinician must be able to work ... and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility...teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional travel to other… more
- Molina Healthcare (Las Cruces, NM)
- …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
- Sanford Health (SD)
- …activities relating to the implementation, ongoing evaluation, and improvements to UM and/or prior authorization processes with applicable. ... regulations and internal policies that effect resource utilization and potentially, prior authorization . Assists the department in monitoring the utilization… more
- Molina Healthcare (Seattle, WA)
- …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