- UnitedHealth Group (Phoenix, AZ)
- …CMO and leadership team. They will support the CMO with utilization management (UM), prior authorization determinations, oversight and direction of ... inpatient and skilled nursing facility utilization , oversight and direction of Outpatient Care ... utilization , oversight and direction of Outpatient Care Management Services, Medicare Risk Adjustment Factor (RAF) education as… more
- NY CREATES (Albany, NY)
- …SUMMARY The Manager of Device Integration will be responsible for engineering and management of the NY CREATES Integration and Device Engineering group in support of ... business opportunities with existing and new customers, IP creation and management , and professional development of the Integration and Device Engineering Team.… more
- Blue Shield of California (Oakland, CA)
- Job Description Your Role The Behavioral Health Utilization Management team performs prospective & concurrent utilization reviews and first level ... recognized clinal criteria across multiple lines of business. The Behavioral Health Utilization Management Clinician, Experienced, will report to the Manager of… more
- Blue Shield of California (El Dorado Hills, CA)
- …audit readiness in collaboration with internal BSC partners Perform advanced or complicated prior authorization and concurrent utilization reviews and first ... Job Description Your Role The Behavioral Health (BH) Utilization Management (UM) team performs prospective,...conduct clinical reviews of mental health and substance use authorization requests at various levels of care for medical… more
- Network Health WI (Menasha, WI)
- The RN Coordinator Utilization Management reviews submitted authorization requests for medical necessity, appropriateness of care, and benefit eligibility. ... The RN Coordinator Utilization Management reviews applicable guidelines regarding payment and coverage, and makes determinations for authorization /payment.… more
- Morgan Stephens (Phoenix, AZ)
- Job Title: Physical Therapist (PT) - Utilization Management Organization: Managed Care Organization Must be licensed in Arizona Pay: Up to: $72.00 per hour ... Care Organization is seeking a qualified Physical Therapist (PT) to join our Utilization Management Team. This position will primarily involve conducting chart… more
- NY CREATES (Albany, NY)
- …Job responsibilities include but are not limited to: Virtual Machine Management : Creating, configuring, and managing virtual machines on virtualization platforms ... managing storage infrastructure (SAN, NAS, DAS). Monitoring storage capacity utilization and proactively managing storage expansion. Implementing data protection… more
- ROCKY MOUNTAIN HUMAN SERVICES (Denver, CO)
- …managers serve as the experts in eligibility assessments, service plans, and prior authorization requests (PARs). Essential Duties Responds to correspondence ... in the member's residence. Ensures the PAR is completed prior to services being implemented and matches the assessment...as part of the annual service plan process. Submits utilization reviews to the utilization management… more
- Qualderm (Grand Blanc, MI)
- …insurance eligibility, financial status and assigns correct payor type. Verifies if prior authorization from insurance is required; notifies Billing Department, ... on the telephone, answering or referring inquiries. Notes patient arrival in Practice Management System (EMR). Identifies patients by date of birth and name in… more
- Centria Autism (Indianapolis, IN)
- …experience Master's degree preferred Work Experience 2-5 years of experience in operations management or sales, prior management of a team required. ... center tours, and serving as a liaison with facility management to help maintain a clean and safe working...and Supervising Clinicians to start new cases and confirm authorization , ensuring a smooth case start. Coordinate staffing activities,… more
- Mindful Care (New York, NY)
- …care while maintaining control over their schedule. We handle patient scheduling, prior authorizations, case management , billing, and other support functions. ... Our model emphasizes supportive therapy and non-stimulant or non-narcotic medication management for our patients. Your Qualifications: Completion of a Master's… more
- Physician Partners of America (Dallas, TX)
- …directed by PPOA Policy and procedures Works professionally and as a team Medication Prior Authorization Diagnostic testing prior authorization BXMO (If ... and general public Ability to make decisions and solve problems Preferred: Nursing (Medical) Assistant certification Pain Management Practice prior experience more
- NorthShore (Arlington Heights, IL)
- …prior to date of service. Minimizes third party payer denials by verifying authorization of service prior to forwarding patients to service delivery areas. ... support to primary care practices and specialty care providers regarding utilization , authorization and referral activities. Communicates effectively with… more
- ADELANTE HEALTHCARE INC (Surprise, AZ)
- …with patients to develop self- management goals, provide insurance, referral, and prior authorization support, and may also conduct patient outreach to follow ... Prepare for the patient appointment by reviewing and updating patient records prior to patient arrival Interview patient to obtain reason for visit: chief… more
- UC Davis Health (Sacramento, CA)
- … authorization requests to requesting parties. Assists with processing of prior authorization and patient assistance program requests. Maintains database of ... in Health System Outpatient Pharmacy. Experience working in a Specialty Pharmacy. Prior Authorization and/or Patient Assistance Program experience in Epic EMR,… more
- LONGEVITI LLC (Pasadena, CA)
- …out. Draft reports should also be made available upon request of the DCSA Senior Management for review prior to being sent outside of DCSA, when required. ... by the assigned Division/Directorates task managers, as required. Records and File Management : Perform record and file management and maintenance. Responsible… more
- Marathon Health (Indianapolis, IN)
- …cards and cash, tallying the cash drawer and preparing deposits. May complete prior authorization paperwork for insurance, fax communications for referrals, or ... or on the telephone. Optimizes patients' satisfaction, provider time, and room utilization by scheduling appointments in person or by telephone Keeps patient… more
- Banner Health (Phoenix, AZ)
- …met for our wholly owned and delegated plans in the areas of prior authorization , census management , prospective/concurrent/retro review, and appeals. Care ... Areas of responsibility could include but are not limited to: Utilization management : Leading teams and partnering with Senior leaders to ensure appropriate… more
- Kind Behavioral Health (Huntersville, NC)
- …resource allocation, and onboarding workflows. Assist the Clinic Director with utilization management and support revenue-driving activities. Contribute to ... with regulatory & compliance standards, including BACB ethics, HIPAA, and insurance authorization processes. 2+ years experience in case management & clinical… more
- Regional One Health (Memphis, TN)
- …effects, special precautions, missed doses, etc. when indicated. Contacts providers concerning prior authorization and medical necessity drugs for third party ... of administration. *Consults on drug therapy, drug regimen review and drug utilization review. *Consults on drug storage and control. *Consults on research projects… more
