Pre Authorization Nurse Jobs

Become a part of our caring community 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 Pre-Authorization Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Pre-Authorization Nurse completes medical necessity and level of care reviews for requested services using clinical judgment, and refers to team members for review depending on case findings. Educate providers on utilization and medical management processes. Enter and maintain relevant clinical information in various medical management systems. Understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. Use your skills to make an impact Required Qualifications 2+ years of RN experience Active RN license in the state of Indiana Ability to be licensed in multiple states without restrictions Previous experience in utilization management, case management, discharge planning and/or home health or rehab Proficient with MS Office products including Word, Excel and Outlook Ability to work independently under general instructions and with a team Preferred Qualifications Bachelor's degree MCO experience Health Plan experience working with large carriers Previous Medicare/Medicaid experience Outpatient or home health experience in Utilization Manageme

Abbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines. Our 122,000 colleagues serve people in more than 160 countries. JOB DESCRIPTION: About Abbott Abbott is a global healthcare leader, creating breakthrough science to improve people’s health. We’re always looking towards the future, anticipating changes in medical science and technology. The Opportunity This position works out of our Lake Mary location in the Abbott Heart Failure, Acelis Connected Health business. Our Heart Failure solutions are helping address some of the World’s greatest healthcare challenges. As the Verification of Benefits Specialist, you’ll have the chance to assist our patients in having accurate insurance information on file and collecting authorizations or PCP referrals as needed. What You'll Do The following reflects management’s definition of essential functions for this job but does not restrict the tasks that may be assigned. Management may assign or reassign duties and responsibilities to this job at any time due to reasonable accommodation or other reasons. Contacts insurance companies to verify insurance benefits. Initiates Pre-authorization, PCP referral and Letter of Agreement requests for new and ongoing services with insurance companies and performs follow up activities for an outcome. Files Appeals for denied coverage to insurance companies as needed. Maintains customer records in practice management system related to benefit coverage, coordination of benefits, authorizations, denials, appeals, outcomes and communication with insurance companies. </

Become a part of our caring community The Care Management Support Assistant contributes to administration of care management. Provides non-clinical support to the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Care Management Support Assistant performs basic administrative/clerical/operational/customer support/computational tasks. Typically works on routine and patterned assignments. The Care Management Support Assistant will review inbound referrals and correspondence for processing, fulfilment or resolution utilizing all appropriate software systems and resources. Screen physician’s orders and documentation to identify that all qualifying medical documentation and required information is included. When necessary, request additional applicable information from referring entity. Perform verification of benefits coverage and eligibility for services per Health Plan contract. Review referral data matching it against specified medical terms and diagnoses or procedure codes and follow established procedures for approving request or referring request for further review. Provide referral management education to members and providers regarding medical benefits, referral status and prior authorizations. Communicate with patient to confirm demographics and explain the details of the services/care requested. Coordinate the timely delivery of care and services with providers. Also communicate with referring entities, providers, and members regarding final referral determination while maintaining detailed documentation to record patient, physician, referral source and provider interactions and communications. Work with Pre-Authorization, Utilization Management, Billing, Pharmacy, and Home Care r

Secure Every Identity, from AI to Human Identity is the key to unlocking the potential of AI. Okta secures AI by building the trusted, neutral infrastructure that enables organizations to safely embrace this new era. This work requires a relentless drive to solve complex challenges with real-world stakes. We are looking for builders and owners who operate with speed and urgency and execute with excellence. This is an opportunity to do career-defining work. We're all in on this mission. If you are too, let's talk. Auth0 is an easy-to-implement, authentication and authorization platform designed by developers for developers. We make applications’ login boxes safe, secure, and seamless for anyone logging in. About the Role We are seeking a Product Manager to join our Enterprise Federation team. In this role, you will partner closely with engineering teams to shape the future of Auth0's core B2B platform. We need a creative, engineering-minded leader to uncover and solve the complex operational realities our customers face when deploying high-scale, multi-tenant B2B applications on Auth0. As the owner of the "front door" to Auth0 B2B, you will directly shape how our enterprise customers—and their end-users—experience our platform. Core Responsibilities & Ownership You will lead two critical product areas: Enterprise Connections: A suite of pre-built connectors that integrate workforce Identity Providers (IdPs), enabling a seamless onboarding experience for enterprise B2B customers. B2B Connect: An innovative offering that allows Auth0 to be deployed on top of—rather than instead of—a customer's existing IdP. In addition to managing these areas, you will: Drive Modularization: Focus on modularizing Auth0’s B2B offerings so customers can quickly adopt high-value features without needing a full identity migration. Lead the Standards Roadmap: Deepen your understanding of regional and vertical identity standards to build, drive, and propel a highly competitive stan

Software is eating the world, but AI is eating software. We live in unprecedented times – AI has the potential to exponentially augment human intelligence. Every person will have a personal tutor, coach, assistant, personal shopper, travel guide, and therapist throughout life. As the world adjusts to this new reality, leading platform companies are scrambling to build LLMs at billion scale, while large enterprises figure out how to add it to their products. To make them safe, aligned and actually useful, these models need human eval and reinforcement learning through human feedback (RLHF) during pre-training, fine-tuning, and production evaluations. This is the main innovation that’s enabled ChatGPT to get such a large headstart among competition. At Scale, our products include the Generative AI Data Engine, SGP, Donovan, and others that power the most advanced LLMs and generative models in the world through world-class RLHF, human data generation, model evaluation, safety, and alignment. The data we are producing is some of the most important work for how humanity will interact with AI. At the foundation of these products is the Identity Engineering team. In this role, you will help support the design and development of core software systems specifically focused on identity, access management, authorization, and authentication. You’ll also get widespread exposure to the forefront of the AI race as Scale sees it in enterprises, startups, governments, and large tech companies. You will: Drive the design, and implementation of our identity infrastructure to ensure secure authentication and authorization across enterprise systems. Build software for authentication mechanisms such as Single Sign-On (SSO), Multi-Factor Authentication (MFA), and federated identity solutions (SAML, OAuth, OpenID Connect). Build software for authorization mechanisms such as Relation-based access control (ReBAC), Attribute-based access control (ABAC), Role-based access cont

Software is eating the world, but AI is eating software. We live in unprecedented times – AI has the potential to exponentially augment human intelligence. Every person will have a personal tutor, coach, assistant, personal shopper, travel guide, and therapist throughout life. As the world adjusts to this new reality, leading platform companies are scrambling to build LLMs at billion scale, while large enterprises figure out how to add it to their products. To make them safe, aligned and actually useful, these models need human eval and reinforcement learning through human feedback (RLHF) during pre-training, fine-tuning, and production evaluations. This is the main innovation that’s enabled ChatGPT to get such a large headstart among competition. At Scale, our products include the Generative AI Data Engine, SGP, Donovan, and others that power the most advanced LLMs and generative models in the world through world-class RLHF, human data generation, model evaluation, safety, and alignment. The data we are producing is some of the most important work for how humanity will interact with AI. At the foundation of these products is the Identity Engineering team. In this role, you will help support the design and development of core software systems specifically focused on identity, access management, authorization, and authentication. You’ll also get widespread exposure to the forefront of the AI race as Scale sees it in enterprises, startups, governments, and large tech companies. You will: Drive the design, and implementation of our identity infrastructure to ensure secure authentication and authorization across enterprise systems. Build software for authentication mechanisms such as Single Sign-On (SSO), Multi-Factor Authentication (MFA), and federated identity solutions (SAML, OAuth, OpenID Connect). Build software for authorization mechanisms such as Relation-based access control (ReBAC), Attribute-based access control (ABAC), Role-based access cont

Who we are About Stripe Stripe is a financial infrastructure platform for businesses. Millions of companies - from the world’s largest enterprises to the most ambitious startups - use Stripe to accept payments, grow their revenue, and accelerate new business opportunities. Our mission is to increase the GDP of the internet, and we have a staggering amount of work ahead. That means you have an unprecedented opportunity to put the global economy within everyone's reach while doing the most important work of your career. About the team Specialist Solutions Architects (SSA) are domain experts aligned to specific Stripe solutions and customer buying centers. We have in-depth knowledge of specific solution offerings and a deep understanding of customer challenges. We align with specialist product sellers on deals, advise the broader pre-sales team on complex opportunities, support pipeline development and revenue attainment, serve as an advisor on go-to-market sales plays, and provide critical insights to our product and engineering teams. What you’ll do You will collaborate closely with sales and pre-sales teams to drive pipeline and revenue targets, while also educating the product and engineering teams on market trends and strongly influencing the product roadmap. You will develop deep relationships with senior customer business leaders and grow Stripe's solution offerings with new and existing customers. As a subject matter expert, you will scale the broader organization by creating reusable assets and coaching others on complex, high-value opportunities.The team is looking for a payments optimization specialist with a proven track record of designing and deploying payment infrastructure for global enterprises. You will engage with customers as a thought leader in the advanced payments stack - helping them navigate multi-PSP environments, payment orchestration, adaptive pricing, and buy-now-pay-later integrations to maximize authorization rates, reduce costs, and impr

Secure Every Identity, from AI to Human Identity is the key to unlocking the potential of AI. Okta secures AI by building the trusted, neutral infrastructure that enables organizations to safely embrace this new era. This work requires a relentless drive to solve complex challenges with real-world stakes. We are looking for builders and owners who operate with speed and urgency and execute with excellence. This is an opportunity to do career-defining work. We're all in on this mission. If you are too, let's talk. Auth0 is an easy-to-implement, authentication and authorization platform designed by developers for developers. We make applications’ login boxes safe, secure, and seamless for anyone logging in. About the Role We are seeking a Senior Product Manager to join our Enterprise Federation team. In this role, you will partner closely with engineering teams to shape the future of Auth0's core B2B platform. We need a creative, engineering-minded leader to uncover and solve the complex operational realities our customers face when deploying high-scale, multi-tenant B2B applications on Auth0. As the owner of the "front door" to Auth0 B2B, you will directly shape how our enterprise customers—and their end-users—experience our platform. Core Responsibilities & Ownership You will lead two critical product areas: Enterprise Connections: A suite of pre-built connectors that integrate workforce Identity Providers (IdPs), enabling a seamless onboarding experience for enterprise B2B customers. B2B Connect: An innovative offering that allows Auth0 to be deployed on top of—rather than instead of—a customer's existing IdP. In addition to managing these areas, you will: Drive Modularization: Focus on modularizing Auth0’s B2B offerings so customers can quickly adopt high-value features without needing a full identity migration. Lead the Standards Roadmap: Deepen your understanding of regional and vertical identity standards to build, drive, and propel a highly competiti

Senior Relocation Specialist - US Immigration Company: The Boeing Company Boeing’s Global Mobility Services organization is currently seeking Senior Relocation Specialists to join our International Relocation team in Hazelwood, MO ; Mesa, AZ ; Plano, TX or Seattle, WA . These roles will support our U.S. immigration and global relocation programs, ensuring compliance, operational efficiency, and a superior employee experience. These selected candidates will also manage immigration processes related to employee relocations and assignments while partnering closely with HR, Talent Acquisition, Legal, Payroll, and third-party suppliers to manage immigration and relocation processes end to end. This is a high-impact role that requires speed, clarity, timeliness and accuracy to drive compliance and deliver critical support for immigration and mobility services. The successful candidates will serve as a trusted immigration subject matter expert (SME), navigating an evolving U.S. immigration landscape while designing the systems and policies that enable Boeing to build a global talent pipeline while delivering a seamless employee experience. Position Responsibilities: Serve as SME for U.S. immigration programs while providing guidance on visa, work authorization, and immigration compliance matters Manage immigration and relocation cases from initiation through completion. Manage the end-to-end U.S. immigration lifecycle, from offer and pre-hire assessment through visa processing, extensions, renewals, permanent residency, and other applicable immigration matters, including H-1B, O-1, J-1, TN, E-3, L-1, F-1 OPT/STEM, PERM, and LCAs Partner with Talent Acquisition, Human Resources, hi

Secure Every Identity, from AI to Human Identity is the key to unlocking the potential of AI. Okta secures AI by building the trusted, neutral infrastructure that enables organizations to safely embrace this new era. This work requires a relentless drive to solve complex challenges with real-world stakes. We are looking for builders and owners who operate with speed and urgency and execute with excellence. This is an opportunity to do career-defining work. We're all in on this mission. If you are too, let's talk. Okta is the leading independent provider of enterprise identity. Auth0 enables organizations to securely connect the right people to the right technologies at the right time. With over 7,000 pre-built integrations to applications and infrastructure providers, Okta customers can easily and securely use the best technologies for their business. Over 10,000 organizations, including 20th Century Fox, JetBlue, Nordstrom, Slack, Teach for America, and Twilio, trust Okta to help protect the identities of their workforces and customers. Auth0 is an easy-to-implement, authentication and authorization platform designed by developers for developers. We make applications’ login boxes safe, secure, and seamless for anyone logging in. Position Description : We are looking for a Principal Group Product Manager to join our team. You will work with our engineering teams to shape the future of our products. We are looking for a creative, engineering-minded individual to uncover and solve the highly complex operational realities that face our customers when they deploy high-scale, multi-tenant B2B applications on top of Auth0. This individual will help shape the next generation of our Tenancy-as-a-Service (TaaS) offeri

Secure Every Identity, from AI to Human Identity is the key to unlocking the potential of AI. Okta secures AI by building the trusted, neutral infrastructure that enables organizations to safely embrace this new era. This work requires a relentless drive to solve complex challenges with real-world stakes. We are looking for builders and owners who operate with speed and urgency and execute with excellence. This is an opportunity to do career-defining work. We're all in on this mission. If you are too, let's talk. Okta is the leading independent provider of enterprise identity. Auth0 enables organizations to securely connect the right people to the right technologies at the right time. With over 7,000 pre-built integrations to applications and infrastructure providers, Okta customers can easily and securely use the best technologies for their business. Over 10,000 organizations, including 20th Century Fox, JetBlue, Nordstrom, Slack, Teach for America, and Twilio, trust Okta to help protect the identities of their workforces and customers. Auth0 is an easy-to-implement, authentication and authorization platform designed by developers for developers. We make applications’ login boxes safe, secure, and seamless for anyone logging in. Position Description : We are looking for a Principal Group Product Manager to join our team. You will work with our engineering teams to shape the future of our products. We are looking for a creative, engineering-minded individual to uncover and solve the highly complex operational realities that face our customers when they deploy high-scale, multi-tenant B2B applications on top of Auth0. This individual will help shape the next generation of our Tenancy-as-a-Service (TaaS) offeri

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Review and adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims; adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines. Process provider refunds and returned checks. May handle customer service inquiries and problems. Perform adjustments across all dollar amount level on customer service platforms by using technical and claims processing expertise. Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process. Performs claim re-work calculations. Follow through completion of claim overpayments, underpayments, and any other irregularities. Process complex non-routine Provider Refunds and Returned Checks. Review and interpret medical contract language using provider contracts to confirm whether a claim is overpaid to allocate refund checks. Handle telephone and written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals. Ensures all compliance requirements are satisfied and that all payments are made following company practices and procedures. Review and handle relevant correspondences assigned to the team that may result in adj

Become a part of our caring community The Medical Director, National Outpatient Medicare leverages clinical expertise and medical judgment to review preauthorization requests for services. This role is responsible for evaluating moderately complex to complex cases, where analysis of clinical information and situational factors requires in-depth assessment and sound decision-making. As a Medical Director at Humana , you will use your clinical expertise and judgment to make meaningful coverage and care determinations that support quality, consistency, and compliance across the healthcare continuum. In this role, you will review requests for services, level of care, and site of service, using nationally recognized clinical guidelines, CMS policies, medical references, and internal clinical resources to guide decision-making. This position offers the opportunity to work on complex outpatient cases , review clinical documentation, and collaborate with both internal partners and external physicians to gather additional information and discuss determinations. You may also contribute to care management activities and, depending on the role, provide input on areas such as clinical documentation, coding, grievances and appeals, and outpatient services or equipment reviews. Beyond case review, this role provides the opportunity to build strong relationships with physicians, provider groups, facilities, and community partners in support of regional priorities. It is a strong fit for physicians who are interested in contributing to value-based care, population health, and care management strategies while working in a structured environment that values sound clinical judgment, collaboration, and operational excellence. Humana is seeking a Medical Director to

Job Details: Job Description: Intel is shaping the future of technology to help create a better future for the entire world. Our work in pushing forward fields like AI, analytics, and cloud-to-edge technology is at the heart of countless innovations. With a career at Intel, you'll have the opportunity to use technology to power major breakthroughs and create enhancements that improve our everyday quality of life. Join us and help make the future more wonderful for everyone. Want to learn more? Visit our YouTube Channel or the link below. Life at Intel The Role and Impact As a SoC Power Thermal Performance Validation and Optimization Engineer, you will play an essential role in ensuring Intel's products achieve optimal power, thermal, and performance benchmarks at the system-on-chip (SoC) level. In this position, you will develop and execute validation methodologies, optimize hardware/software solutions, and perform SoC-level debugging to address power, thermal, and performance challenges. Your contribution will directly impact Intel's ability to deliver competitive, high-performing products to market. Business Group This role is part of Intel's Data Center Group (DCG), which focuses on designing innovative solutions to power the next generation of computing platforms for data centers. As a member of the PTP PreSi Correlation Solution team, you will contribute to shaping the development and validation processes for cutting-edge technologies, ensuring Intel meets and exceeds industry standards for performance and efficiency. Key Responsibilities: Develop and execute SoC-level power, thermal, and performance validation and

Abbott is a global healthcare leader that helps people live more fully at all stages of life. Our portfolio of life-changing technologies spans the spectrum of healthcare, with leading businesses and products in diagnostics, medical devices, nutritionals and branded generic medicines. Our 122,000 colleagues serve people in more than 160 countries. JOB DESCRIPTION: Job Description Position Overview The Pre-Analytical Laboratory Technician II is responsible for preparing samples for analysis, recording, and/or verifying patient’s information. This role is primarily responsible for performing duties related to accessioning, sample management, problem resolution, data entry, and specimen storage with high degree of proficiency. A successful candidate would be expected to have the ability to swiftly pick up new laboratory process that they are trained in due to experience gained in previous laboratory roles. Potential candidates should be able to demonstrate that they have good documentation practices (GDP) knowledge. Shift: Tuesday - Saturday, 9:00am – 5:30pm Essential Duties Include, but are not limited to, the following: Perform laboratory tasks, as assigned. Clean and organize common lab areas and take responsibil