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Utilization Management Nurse, Senior (Prior Authorization)
Blue Shield of CA - Oakland, California, United States, 94616 6 days ago
Your Role The Utilization Management Prior Authorization team accurate and timely prior authorization of designated healthcare services, continuity or...
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Prior Authorization Pharmacy Tech
US Tech Solutions, Inc. - New York, New York, United States 9 days ago
Responsibilities:The Tech I Prior Auth takes in-bound calls from providers, pharmacies, members, etc providing professional and courteous ph...
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Medical Authorization Assistant
CA_CalOptima_CalOptima Health - Orange, California, United States, 92613 20 hours ago
DetailsClient Name
CA_CalOptima_CalOptima Health
Job Type
Travel
Offering
Nursing
Profession
Certified Medical Assistant (CMA)
Specialty
Med...
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Prior Authorization Coordinator
Associated Physicians, LLP - Madison, WI, United States 4 days ago
*Prior Authorization Coordinator - Pay & Perks:** Competitive Pay Based on Experience* Free Parking* 1 location near Hilldale Mall!
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Prior Authorization Specialist
Blink Health - Pittsburgh, PA, United States 5 days ago
Company Overview:Blink Health is the fastest growing healthcare technology company that builds products to make prescriptio...
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Prior Authorization Specialist
Insight Global - Charlottesville, Virginia, United States, 22904 2 days ago
Pay Rate: 18hr-27hr
-Onsite Charlottesville, VA 5 days/ weekInsight Global is seeking a Prior Authorization Specialist for one of the Top ra...
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Go to next pageBlue Shield of CA - Oakland, California, United States, 94616
Work at Blue Shield of CA
Your Role The Utilization Management Prior Authorization team accurate and timely prior authorization of designated healthcare services, continuity or care, and access to care clinical review determinations. The Utilization Management Nurse, Senior will report to the Manager, Utilization and Medical Review. In this role you will be performing first level determination approvals for members using BSC evidenced based guidelines, policies, and nationally recognized clinical criteria across lines of business or for a specific line of business such as Medi-Cal and Medicare. Successful RN candidate reviews prior auth requests for medical necessity, coding accuracy and medical policy compliance. Clinical judgment and detailed knowledge of benefit plans used to complete review decisions is required Your Knowledge and Experience
Requires a bachelor's degree or equivalent experience
Requires a current California RN License
Requires at least 5 years of prior relevant experience
Requires practical knowledge of job area typically obtained through advanced education combined with experience
Experience working with or for a manage health care plan preferred
Experience with Medi-Cal managed care including Medicare preferred Effective time management skills and ability to define and act on priorities efficiently preferred
Excellent communication skills both orally and in writing with all levels of BSC Promise staff, members, contracted physicians, and participating provider groups preferred
See details and apply
Utilization Management Nurse, Senior (Prior Authorization)