Pre Authorization Nurse in United States

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

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

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

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: 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: Monday-Friday: 11am-7:30pm PST Essential Duties Include, but are not limited to, the following: Perform laboratory tasks, as assigned. Clean and organize common lab areas and take responsibility for all housekeeping tasks being completed on time. Receive, sort, and unpack incoming samples regularly. Unpack, log and track incoming samples using specified software regularly. Perform administrative duties required for incoming samples; including, but not limited to scan needed paperwork, such as pathology reports and requisitions and file physical paperwork per required procedures. Perform order entry and order processing such as in lieu of; including, but not limited to reviewing patient demographics and sample collection. Evaluate insurance and verify billing information. Transcri

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: 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: Monday-Thursday, Saturday: 9am-5:30pm PST Essential Duties Include, but are not limited to, the following: Perform laboratory tasks, as assigned. Clean and organize common lab areas and take responsibility for all housekeeping tasks being completed on time. Receive, sort, and unpack incoming samples regularly. Unpack, log and track incoming samples using specified software regularly. Perform administrative duties required for incoming samples; including, but not limited to scan needed paperwork, such as pathology reports and requisitions and file physical paperwork per required procedures. Perform order entry and order processing such as in lieu of; including, but not limited to reviewing patient demographics and sample collection. Evaluate insurance and verify billing information. <

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: 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: Monday-Friday: 11am-7:30pm PST Essential Duties Include, but are not limited to, the following: Perform laboratory tasks, as assigned. Clean and organize common lab areas and take responsibility for all housekeeping tasks being completed on time. Receive, sort, and unpack incoming samples regularly. Unpack, log and track incoming samples using specified software regularly. Perform administrative duties required for incoming samples; including, but not limited to scan needed paperwork, such as pathology reports and requisitions and file physical paperwork per required procedures. Perform order entry and order processing such as in lieu of; including, but not limited to reviewing patient demographics and sample collection. Evaluate insurance and verify billing information. Transcri

Position Overview As a Solutions Engineer at Diligent, you will partner closely with Sales to help organizations understand how our platform can transform the way they identify and mitigate risk, perform audits, strengthen controls, and operationalize broader GRC programs. You’ll independently lead the SE workstream on small to mid-sized opportunities, while partnering with more senior Solutions Engineers on complex, multi-pillar deals, acting as a trusted partner to customer stakeholders and helping translate Risk & Audit and broader GRC challenges into clear, compelling solutions that drive business value. If you enjoy combining domain expertise, storytelling, solution design, and customer interaction and are looking to build your career in a commercial, customer-facing environment, this is a strong next step. Key Responsibilities Customer & Commercial Partnership Partner with Sales to lead the full pre-sales lifecycle for small to mid-sized opportunities, helping customers understand how Diligent solves real-world risk, audit, and control management challenges. Deliver independent, well-prepared, tailored software demonstrations that clearly articulate business value, while seeking coaching and feedback from senior team members for continuous improvement. Engage confidently with stakeholders across Internal Audit, Risk, Compliance, IT, Controls, and Governance teams, owning day-to-day customer conversations and escalating to senior SEs for high-risk or complex topics as needed. Translate customer pain points into clear solution narratives, including outcomes and success criteria, to support deal progression and closure. Own the technical win for small to mid-sized opportunities, and contribute to the technical strategy on larger, multi-stakeholder deals in partnership with senior SEs. Solution Design & Thought Leadership Design and present solu

Synthesia is the world’s leading AI video platform for business, used by over 90% of the Fortune 100. Founded in 2017, the company is headquartered in London, with offices and teams across Europe and the US. As AI continues to shape the way we live and work, Synthesia develops products to enhance visual communication and enterprise skill development, helping people work better and stay at the center of successful organizations. Following our recent Series E funding round, where we raised $200 million, our valuation stands at $4 billion. Our total funding exceeds $530 million from premier investors including Accel, NVentures (Nvidia's VC arm), Kleiner Perkins, GV, and Evantic Capital, alongside the founders and operators of Stripe, Datadog, Miro, and Webflow. About the role… We are hiring a Director of Sales Operations to own the operating rhythm of our pre-sales engine globally: Sales, Sales Development, and Sales Engineering. This is a player/coach role leading a small team of experienced senior operators while staying hands-on, and our first Sales Operations leadership seat in North America. This role reports to the VP of Revenue Operations. What you’ll be doing… Forecasting and pipeline inspection. Own forecast methodology, accuracy, and variance analysis end to end for Sales and Sales Development; run the weekly commit and pipeline inspection cadence; build the leading indicators (stage conversion, velocity, slippage, aged pipeline) that make the forecast defensible before quarter end, not explained after it. Sales process and policy. Own the pre-sales process architecture: opportunity stages, exit criteria, qualification standards, pipeline hygiene rules, rules of engagement, and the SDR-to-AE handoff, including how conflicts get resolved. Sales Engineering coverage. Own the SE deployment model (SE-to-AE coverage ratios, prioritization of scarce SE time), standardize the technical proof-of-concept and demo process, and build the reporting that shows technical w

Fin is the AI Customer Agent company on a mission to help businesses provide perfect customer experiences. Our AI Agent Fin is the highest-performing AI Customer Agent on the market today, enabling businesses to deliver impeccable, always-on customer support across the customer journey – from service, to sales, to ecommerce. Powered by our own AI models, Fin resolves complex customer issues end-to-end across every channel, with minimal set-up and integration. Fin can also be combined with our natively integrated Intercom help desk for one single system that is designed to meet the needs of modern day support teams. Founded in 2011, Fin became one of the fastest growing companies and remains one of the largest private software companies in the world with nearly 30,000 global businesses using our products to transform their customer support. Driven by our core values, we push boundaries, build with speed and intensity, and relentlessly deliver incredible value to our customers. What's the opportunity? Fin is looking for an exceptional Senior Solutions Engineer to join our vibrant Customer Solutions Team. In this role, you’ll engage directly with our customers as their trusted advisor, playing a pivotal part in defining and demonstrating value across the entire sales cycle. With a natural curiosity, independent thinking, and strong problem-solving skills, you’ll partner closely with Product, R&D, and Engineering to ensure our customers’ needs and insights are at the core of our AI powered solutions. What will I be doing? Lead technical discovery to identify and address our customers’ needs Deliver an exceptional pre-sales experience by articulating Fin's value and technical expertise Conduct impactful, value-based solution reviews and in-depth technical sessions Design and lead tailored Proof of Concepts (POCs) that showcase Fin's capabilities Serve as the primary resource for RFPs and customer security questions, utilizing standardized materials and es

Fin is the AI Customer Agent company on a mission to help businesses provide perfect customer experiences. Our AI Agent Fin is the highest-performing AI Customer Agent on the market today, enabling businesses to deliver impeccable, always-on customer support across the customer journey – from service, to sales, to ecommerce. Powered by our own AI models, Fin resolves complex customer issues end-to-end across every channel, with minimal set-up and integration. Fin can also be combined with our natively integrated Intercom help desk for one single system that is designed to meet the needs of modern day support teams. Founded in 2011, Fin became one of the fastest growing companies and remains one of the largest private software companies in the world with nearly 30,000 global businesses using our products to transform their customer support. Driven by our core values, we push boundaries, build with speed and intensity, and relentlessly deliver incredible value to our customers. What's the opportunity? Fin is looking for an exceptional Senior Solutions Engineer to join our vibrant Customer Solutions Team. In this role, you’ll engage directly with our customers as their trusted advisor, playing a pivotal part in defining and demonstrating value across the entire sales cycle. With a natural curiosity, independent thinking, and strong problem-solving skills, you’ll partner closely with Product, R&D, and Engineering to ensure our customers’ needs and insights are at the core of our AI powered solutions. What will I be doing? Lead technical discovery to identify and address our customers’ needs Deliver an exceptional pre-sales experience by articulating Fin's value and technical expertise Conduct impactful, value-based solution reviews and in-depth technical sessions Design and lead tailored Proof of Concepts (POCs) that showcase Fin's capabilities Serve as the primary resource for RFPs and customer security questions, utilizing standardized materials and es