Prior Authorization Nurse

This position works as an Authorization Nurse in UPMC, providing support to departments and healthcare providers by obtaining referrals and/or authorizations for acute admissions. The role involves using clinical care experience to assess medical necessity. · Serve as a liaison b ...

Job summaryUPMC is hiring a full-time Authorization Nurse to support the Pre-Arrival department. · ResponsibilitiesServe as a liaison between care managers and payors and facilitates payor/physician contact when indicated. · ...

The Prior Authorization Review Nurse supports the process that manages all outpatient services. · Plan alternative routes for members to IPA providers and sites of care. · Liaise between case managers, UM coordinators, contracted providers and members. · ...

As a Clinical Review Nurse – Prior Authorization, you will analyze prior authorization requests to determine medical necessity of service. · ...

We are seeking a detail-oriented, efficient, and patient-focused Prior Authorization Nurse to join the Arcare team. In this role, you will be responsible for reviewing and processing authorization requests to ensure compliance with national standards and contractual requirements. ...

This position requires initial on-site training and will transition to a fully remote role once training is completed. · The selected candidate must reside in Minnesota or Wisconsin and have the ability to work onsite in St. Paul, MN as needed.This is a remote opportunity that in ...

1.0 FTE (40 hrs/wk); Monday - Friday, business hours. This position requires initial on-site training, and then will transition to a fully remote role once training is completed. On-site training will be located at the 455 Phalen location in St. Paul. This is a remote opportunity ...

The Prior Authorization Review Nurse is responsible for supporting the process that manages all outpatient services. The goal of the Prior Authorization Review Nurse is to actively participate in the review of, current services being rendered and requests for service, and to foll ...

The Pre-Authorization Nurse reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder.The job involves coordinating care for beneficiaries receiving care outsi ...

Who We Are & What We Do · Tallahassee Memorial Healthcare (TMH) is a private, nonprofit community-based healthcare system that provides care to a 22-county region in North Florida and South Georgia. We are a career destination with over 6,000 colleagues who reflect the diversity ...

The Pre-Authorization Nurse reviews prior authorization requests for appropriate care and setting, · following guidelines and policies.The Pre-Authorization Nurse completes medical necessity and level of care reviews for requested services using clinical judgment. · Sending and r ...

This position promotes quality and cost-effective medical care by applying clinical acumen and policies to prior authorization requests. · This role requires a concentration of specialized staff able to work in highly coordinated teams. ...

The Pre-Authorization Nurse coordinates care for MHS beneficiaries receiving care outside the MTF. · • Coordinate patient transfers and document appropriately in MSR. · • Perform prior authorization reviews according to established HUMANA GOVERNMENT BUSINESS contractual requireme ...

The Authorization and Referral Nurse plays a critical role in supporting optimal patient care. · They synthesize clinical data to ensure accurate prior authorization documentation, manage referrals and maintain compliance with regulatory requirements.Associate's or bachelor's de ...

We are seeking a dedicated Prior Authorization Nurse to join our healthcare team. · This role involves managing prior authorization requests for various medical services and procedures, · ensuring compliance with insurance policies and healthcare regulations. ...

This is Prior Authorization / Utilization Management with provider-facing responsibilities. · ...

This position involves reviewing approximately 20 cases a day for medical necessity. A Prior Authorization Nurse will advocate for and protect members from unnecessary hospital admissions. · ...

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The Pre-Authorization Nurse reviews prior authorization requests for appropriate care and setting, following guidelines and policies. · Sending and receiving telephonic calls averaging · Educates providers on utilization and medical management processes · ...

Lensa is a career site that helps job seekers find great jobs in the US. We are not a staffing firm or agency. Lensa does not hire directly for these jobs, but promotes jobs on LinkedIn on behalf of its direct clients, recruitment ad agencies, and marketing partners. Lensa partne ...