- Medical Mutual of Ohio (OH)
- …perform pre-employment substance abuse and nicotine testing._ **Title:** _Prior Authorization Nurse Reviewer_ **Location:** _Ohio_ **Requisition ID:** _2400509_ ... Board. Bachelor's degree preferred. *3 years' experience as a Registered Nurse with a combination of clinical and utilization/case management experience, preferably… more
- Molina Healthcare (San Francisco, CA)
- **_JOB TITLE: CARE REVIEW CLINICIAN, PRIOR AUTHORIZATION (REGISTERED NURSE , OR LVN)_** **For this position we are seeking a Nurse with previous ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
- US Tech Solutions (May, OK)
- …other clinical colleagues, healthcare professionals and members. + * Follow all prior authorization procedures to guarantee an accurate process on each ... data entry, data management, and reporting. **Experience:** + * Review criteria-based prior authorizations following policy and... prior authorization . + * Train and mentor… more
- Centene Corporation (New York, NY)
- …have an active New York State clinical license.** **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service and ... assess medical necessity of care of member + Escalates prior authorization requests to Medical Directors as...members + Provides feedback on opportunities to improve the authorization review process for members + Performs… more
- US Tech Solutions (LA)
- **Position Summary:** As a Prior Authorization Nurse , you work outside the walls of a hospital setting in a specialty area of the nursing field providing ... indicated by staffing and business needs. **Duties:** + **Registered Nurse with current license in LA state of employment....with a minimum of 1 year in utilization management/ prior authorization review experience. **Experience**… more
- Medical Mutual of Ohio (OH)
- …of medical/pharmacy terminology/coding and managed care processes. Understanding of the medical review (ie, prior authorization ) process and managed care ... of services and procedures. Manages initial, concurrent, and retrospective review of cases, including appeals, through evaluation of clinical information… more
- TEKsystems (Rochester, NY)
- …across all lines of business including Medicare D to determine what type of prior authorization review is required, documents any relevant medication history ... permitted by law including the initial level processing and review of prior authorization requests...and missing information to assist the pharmacist/ nurse /physician in the review process. Develops and… more
- Select Medical (West Orange, NJ)
- **Overview** **Kessler Institute for Rehabilitation** West Orange, NJ ** Prior Authorization Specialist/Payor Relations Specialist ( RN , LPN )** **This is an** ... to receive insurance coverage for the care and services they need, as a Prior Authorization Specialist.** **Responsibilities** As a ** Prior Authorization … more
- Molina Healthcare (UT)
- …benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina ... we are seeking a LVN / LPN or RN Nurse with previous experience in Concurrent Review /_**...+ Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. +… more
- The Arora Group (Bethesda, MD)
- Licensed Practical Nurse (LPN) - Utilization Review Nurse Currently recruiting a Licensed Practical Nurse (LPN/LVN) - Utilization Review in Bethesda, ... required on Federal holidays. DUTIES OF THE LICENSED PRACTICAL NURSE (LPN/LVN) - UTILIZATION REVIEW : + Initiate,...process. + The Contractor performing as the License Practical Nurse (LPN) Utilization Reviewer (UR) shall make… more