Candidates are invited to submit their resumes to join a talent community for future consideration by hiring teams. The role involves supporting a value-driven healthcare organization in its mission to provide accessible and affordable care.
The Prior Authorization Nurse evaluates and processes authorization requests to ensure medical necessity and alignment with clinical guidelines. They act as a liaison between providers, patients, and health plans to facilitate coverage decisions and maintain regulatory compliance.
The UM Nurse evaluates and processes prior authorization requests for medical services, medications, and procedures to ensure clinical necessity and benefit coverage. They also act as a liaison between providers, patients, and health plans while maintaining accurate documentation and compliance with regulatory standards.
The Utilization Management Nurse processes prior authorization requests for medical services, medications, and procedures to ensure clinical necessity and benefit coverage. They collaborate with medical directors and healthcare providers to facilitate authorization decisions while maintaining compliance with regulatory standards.
The Concurrent Utilization Review Nurse conducts real-time clinical reviews to ensure the medical necessity and appropriateness of healthcare services. They also collaborate with medical directors and care teams to facilitate seamless care transitions and manage authorization requests.
This role provides functional and technical support for Oracle Financials and EPM Cloud applications while driving strategic delivery for finance and accounting workstreams. The analyst collaborates with stakeholders to manage requirements, system enhancements, integrations, and data governance processes.
The UM Nurse facilitates quality, cost-effective care by coordinating services, identifying member needs, and planning care across the continuum. They are responsible for performing medical necessity reviews and ensuring timely discharge planning in collaboration with clinical teams.
Develop and maintain data properties, including the creation of APIs, microservices, and ETL pipelines using Scala. Implement AI-driven solutions through LLM fine-tuning and RAG frameworks while supporting Azure-based data ingestion.
