23 prior authorization clinical review nurse jobs found

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.  If you are located in the Massachusetts area, you will have the flexibility to work remotely* as well as work in the field as you take on some tough challenges. •**Travel within territory 100% of the time and assist when needed in the state of Massachusetts during audits (9 out of 12 months of the year) (Audits will be conducted onsite removed from patient care areas); the other 3 out of...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.  If you are located in the Massachusetts area, you will have the flexibility to work remotely* as well as work in the field as you take on some tough challenges. •**Travel within territory 100% of the time and assist when needed in the state of Massachusetts during audits (9 out of 12 months of the year) (Audits will be conducted onsite removed from patient care areas); the other 3 out of...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.  If you are located in the Massachusetts area, you will have the flexibility to work remotely* as well as work in the field as you take on some tough challenges. •**Travel within territory 100% of the time and assist when needed in the state of Massachusetts during audits (9 out of 12 months of the year) (Audits will be conducted onsite removed from patient care areas); the other 3 out of...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.  If you are located in the Massachusetts area, you will have the flexibility to work remotely* as well as work in the field as you take on some tough challenges. •**Travel within territory 100% of the time and assist when needed in the state of Massachusetts during audits (9 out of 12 months of the year) (Audits will be conducted onsite removed from patient care areas); the other 3 out of...

Seeking active independent CA State behavioral health or RN licensed candidates with behavioral health/psychiatric healthcare experience, (LCSW, LMFT, LPCC, RN etc). Previous experience in Eating Disorders or Substance Abuse a plus! This position is responsible for the assessment, reassessment, care planning and coordination of care and services including ongoing monitoring of an appropriate and effective person-centered care plan, member education and care management. Conducts initial and concurrent review for prior authorization of higher levels of care against medical necessity criteria. Responsible for the development of individualized care plans for high and moderate stratified members in the Medicaid, Medicare, and Whole Health markets. Possesses clinical knowledge, understands best practices and continuous learning skills, reviews member records, and works in conjunction with primary care, community benefits, and other support opportunities to develop a long term care...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.  If you are located in the Massachusetts area, you will have the flexibility to work remotely* as well as work in the field as you take on some tough challenges. •**Travel within territory 100% of the time and assist when needed in the state of Massachusetts during audits (9 out of 12 months of the year) (Audits will be conducted onsite removed from patient care areas); the other 3 out of...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.  If you are located in the Massachusetts area, you will have the flexibility to work remotely* as well as work in the field as you take on some tough challenges. •**Travel within territory 100% of the time and assist when needed in the state of Massachusetts during audits (9 out of 12 months of the year) (Audits will be conducted onsite removed from patient care areas); the other 3 out of...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.  If you are located in the Massachusetts area, you will have the flexibility to work remotely* as well as work in the field as you take on some tough challenges. •**Travel within territory 100% of the time and assist when needed in the state of Massachusetts during audits (9 out of 12 months of the year) (Audits will be conducted onsite removed from patient care areas); the other 3 out of...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.  If you are located in the Massachusetts area, you will have the flexibility to work remotely* as well as work in the field as you take on some tough challenges. •**Travel within territory 100% of the time and assist when needed in the state of Massachusetts during audits (9 out of 12 months of the year) (Audits will be conducted onsite removed from patient care areas); the other 3 out of...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.  If you are located in the Massachusetts area, you will have the flexibility to work remotely* as well as work in the field as you take on some tough challenges. •**Travel within territory 100% of the time and assist when needed in the state of Massachusetts during audits (9 out of 12 months of the year) (Audits will be conducted onsite removed from patient care areas); the other 3 out of...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.  If you are located in the Massachusetts area, you will have the flexibility to work remotely* as well as work in the field as you take on some tough challenges. •**Travel within territory 100% of the time and assist when needed in the state of Massachusetts during audits (9 out of 12 months of the year) (Audits will be conducted onsite removed from patient care areas); the other 3 out of...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.  If you are located in the Massachusetts area, you will have the flexibility to work remotely* as well as work in the field as you take on some tough challenges. •**Travel within territory 100% of the time and assist when needed in the state of Massachusetts during audits (9 out of 12 months of the year) (Audits will be conducted onsite removed from patient care areas); the other 3 out of...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.  If you are located in the Massachusetts area, you will have the flexibility to work remotely* as well as work in the field as you take on some tough challenges. •**Travel within territory 100% of the time and assist when needed in the state of Massachusetts during audits (9 out of 12 months of the year) (Audits will be conducted onsite removed from patient care areas); the other 3 out of...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.  If you are located in the Massachusetts area, you will have the flexibility to work remotely* as well as work in the field as you take on some tough challenges. •**Travel within territory 100% of the time and assist when needed in the state of Massachusetts during audits (9 out of 12 months of the year) (Audits will be conducted onsite removed from patient care areas); the other 3 out of...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.  If you are located in the Massachusetts area, you will have the flexibility to work remotely* as well as work in the field as you take on some tough challenges. •**Travel within territory 100% of the time and assist when needed in the state of Massachusetts during audits (9 out of 12 months of the year) (Audits will be conducted onsite removed from patient care areas); the other 3 out of...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.  If you are located in the Massachusetts area, you will have the flexibility to work remotely* as well as work in the field as you take on some tough challenges. •**Travel within territory 100% of the time and assist when needed in the state of Massachusetts during audits (9 out of 12 months of the year) (Audits will be conducted onsite removed from patient care areas); the other 3 out of...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.  If you are located in the Massachusetts area, you will have the flexibility to work remotely* as well as work in the field as you take on some tough challenges. •**Travel within territory 100% of the time and assist when needed in the state of Massachusetts during audits (9 out of 12 months of the year) (Audits will be conducted onsite removed from patient care areas); the other 3 out of...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.  If you are located in the Massachusetts area, you will have the flexibility to work remotely* as well as work in the field as you take on some tough challenges. •**Travel within territory 100% of the time and assist when needed in the state of Massachusetts during audits (9 out of 12 months of the year) (Audits will be conducted onsite removed from patient care areas); the other 3 out of...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.  If you are located in the Massachusetts area, you will have the flexibility to work remotely* as well as work in the field as you take on some tough challenges. •**Travel within territory 100% of the time and assist when needed in the state of Massachusetts during audits (9 out of 12 months of the year) (Audits will be conducted onsite removed from patient care areas); the other 3 out of...

This position is responsible for the assessment, reassessment, care planning and coordination of care and services including ongoing monitoring of an appropriate and effective person-centered care plan, member education and care management. Conducts initial and concurrent review for prior authorization of higher levels of care against medical necessity criteria. Responsible for the development of individualized care plans for high and moderate stratified members in the Medicaid, Medicare, and Whole Health markets. Possesses clinical knowledge, understands best practices and continuous learning skills, reviews member records, and works in conjunction with primary care, community benefits, and other support opportunities to develop a long term care plan to guide the member through their mental health care. Oversees the work of its assigned care support team and work with non-licensed support staff to meet standards of care and performance set by Member Market Leads and the Care...