Top 117 Prior authorization Jobs in New Mexico

RN Supervisor, Appeals, Managed Care, UM
Centene —New Mexico
- $75,300 - $135,400 a year
- Full-time
- Nursing
- RN License
- Mid-level
- Paid holidays
- Health insurance
11d
PRIOR AUTHORIZATIONS-1570
Artesia General Hospital —Artesia, NM
- $15.75 - $29.96 an hour
- Overtime
- Bilingual
- Customer service
- High school diploma or GED
Quick Apply
Remote Client Operations Manager
Verisma —New Mexico
- $70,000 - $75,000 a year
- Full-time
- HIPAA
- Mid-level
- Driver's License
2d
Intake Specialist (Nights)
Haven Behavioral Health —Albuquerque, NM
- CPR Certification
- Computer literacy
- Writing skills
2d
Care Facilitator
Southwestern Home Health, Inc. —Cuba, NM
- From $14.50 an hour
- Full-time
- Background check
- Clean driving record
- Caregiving
- Dental insurance
- 401(k)
Quick Apply
Dental Office Treatment Coordinator / Insurance Specialist
Verve Dental —Los Alamos, NM
- $20 - $26 an hour
- Full-time
- Spanish
- Dental office
- HIPAA
- 401(k)
- Paid time off
Quick Apply
Registered Nurse Case Manager
Twilight Health —Shiprock, NM
- From $42 an hour
- Part-time
- Nursing
- RN License
- Customer service
- Health insurance
- Dental insurance
Quick Apply
Medical Assistant
TriUnity Healthcare LLC —Albuquerque, NM
- $18 - $24 an hour
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Psychiatry
- Health insurance
- Dental insurance
Quick Apply
Billing Supervisor-Prior Authorization and Financial Navigation
New Mexico Cancer Center —Albuquerque, NM
- Full-time
- Background check
- Management
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Medical Assistant
Porch Light Health —Espanola, NM
- $21 - $26 an hour
- Full-time
- Microsoft Word
- Microsoft Excel
- Patient monitoring
- Health insurance
- Dental insurance
Quick Apply
Receptionist
Federal Public Defender, District of New Mexico —Albuquerque, NM
- $41,178 - $51,007 a year
- Full-time
- Microsoft Word
- Background check
- Spanish
- Paid parental leave
- Health savings account
Quick Apply
8d
Medical Scribe
Oak Street Health —Albuquerque, NM
- $17.00 - $28.46 an hour
- Full-time
- Computer literacy
- HIPAA
- Clinic
- Health insurance
- Dental insurance
Medical Receptionist-Bilingual Spanish
Center for Vein Restoration —Rio Rancho, NM
- $16 - $18 an hour
- Full-time
- Spanish
- HIPAA
- Administrative experience
- Paid holidays
- Health insurance
Quick Apply
Patient Service Coordinator - Patient Access, Scheduling
UNM Medical Group, Inc. —Albuquerque, NM
- $36,399 - $44,754 a year
- Full-time
- Mid-level
- 1 year
- Radiology
- Health insurance
- Dental insurance
Quick Apply
9d
Insurance Verification Medical Office
Peak Motion Physical Therapy —Albuquerque, NM
- $19 - $23 an hour
- Full-time
- Background check
- Customer service
- Medical office experience
- Health insurance
- Dental insurance
Quick Apply
5d
Medical Receptionist / Scheduler
X-Ray Associates of New Mexico —Albuquerque, NM
- HIPAA
- High school diploma or GED
- 1 year
Quick Apply
Clinical Administrative Coordinator
Optum —Albuquerque, NM
- $18 - $32 an hour
- Full-time
- Microsoft Outlook
- Medical office experience
- Pass drug screening
- Flexible schedule
1d
Surgery Scheduler/Prior Authorizations- SJHP Obstetrics & Gynecology 610
San Juan Regional Medical Center —Farmington, NM
- Full-time
- Surgery
- Hospital
- Ability to walk for extended periods
Referral Program Coordinator
Lovelace Health System —Albuquerque, NM
- PRN
- Mid-level
- High school diploma or GED
- 2 years
- Opportunities for advancement
- Referral program
Clinic Administrative Assistant - Mental Health
Elevation Counseling —Albuquerque, NM
- $18 - $20 an hour
- Part-time
- Google Workspace
- Microsoft Excel
- Customer service
- Health insurance
- Dental insurance
Quick Apply
1d

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RN Supervisor, Appeals, Managed Care, UM

Centene -
New Mexico

Apply Now

Job Details

Full-time
$75,300 - $135,400 a year
11 days ago

Benefits

Paid holidays
Health insurance
401(k)
Tuition reimbursement
Paid time off

Qualifications

Nursing
RN License
Nursing

Full Job Description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

NOTE: REMOTE RN candidates may reside in any state but a current and active RN license from the state of California is strongly preferred

Position Purpose: Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team.

Monitors and tracks UM resources to ensure adherence to performance, compliance, quality, and efficiency standards
Collaborates with utilization management team to resolve complex care member issues
Maintains knowledge of regulations, accreditation standards, and industry best practices related to utilization management
Works with utilization management team and senior management to identify opportunities for process and quality improvements within utilization management
Educates and provides resources for utilization management team on key initiatives and to facilitate on-going communication between utilization management team, members, and providers
Monitors prior authorization, concurrent review, and/or retrospective clinical review nurses and ensures compliance with applicable guidelines, policies, and procedures
Works with the senior management to develop and implement UM policies, procedures, and guidelines that ensure appropriate and effective utilization of healthcare services
Evaluates utilization management team performance and provides feedback regarding performance, goals, and career milestones
Provides coaching and guidance to utilization management team to ensure adherence to quality and performance standards
Assists with onboarding, hiring, and training utilization management team members
Leads and champions change within scope of responsibility
Performs other duties as assigned
Complies with all policies and standards

Education/Experience:

Requires Graduate of an Accredited School Nursing or Bachelor's degree and 4+ years of related experience.
Strong knowledge of appeals and utilization management principles preferred.

Preferred Experience:

3 - 5 years of direct work experience and knowledge of the appeals process and utilization management principles in managed care/MCO environments is preferred.

License/Certification:

RN - Registered Nurse - State Licensure and/or Compact State Licensure required
For Health Net Federal Services: Must have current and active licensure or certification that permits independent assessment required
For Health Net Federal Services (Medical Management): Certified Managed Care Nurse (CMCN) within 1-1/2 Yrs required
For Health Net Federal Services: US citizenship and current National Agency Check government security clearance required

NOTE: REMOTE RN candidates may reside in any state but a current and active RN license from the state of California is strongly preferred

Pay Range: $75,300.00 - $135,400.00 per year

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Apply Now

Refine Your Search

prior authorization jobs in new mexico

RN Supervisor, Appeals, Managed Care, UM

PRIOR AUTHORIZATIONS-1570

Remote Client Operations Manager

Intake Specialist (Nights)

Care Facilitator

Dental Office Treatment Coordinator / Insurance Specialist

Registered Nurse Case Manager

Medical Assistant

Billing Supervisor-Prior Authorization and Financial Navigation

Medical Assistant

Receptionist

Medical Scribe

Medical Receptionist-Bilingual Spanish

Patient Service Coordinator - Patient Access, Scheduling

Insurance Verification Medical Office

Medical Receptionist / Scheduler

Clinical Administrative Coordinator

Surgery Scheduler/Prior Authorizations- SJHP Obstetrics & Gynecology 610

Referral Program Coordinator

Clinic Administrative Assistant - Mental Health

I want to receive the latest job alert for prior authorization in new mexico

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