- Commonwealth Care Alliance (Boston, MA)
- …Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical areas, including but ... Ensures accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying...Knowledge, Skills & Abilities (must have):** + Experience with prior authorization and retrospective reviews + Proficiency… more
- Commonwealth Care Alliance (Boston, MA)
- …Director of Utilization Management - Oversees clinical decision review for services requiring prior authorization in a variety of clinical areas, including but ... (must have): - Expertise in managing utilization review processes including prior authorization , concurrent and retrospective reviews - Demonstrated ability… more
- Stony Brook University (Stony Brook, NY)
- …with the transferring hospital, Patient Access and physicians and payers for authorization prior to transfer from other hospitals. + Consistent documentation ... RN Case Manager **Position Summary** At Stony Brook Medicine, a...of care from initial assess point. Follows cases for authorization for in patient stay. + Staff review short… more
- HealthCare Support (Houston, TX)
- …systems. Verifies member eligibility, benefit coverage and facility contract status prior to processing authorization requests. Accurately enters the required ... Communicates concerns that arise in these discussions to the Manager and/or Medical Director. 4. Maintains knowledge of the...information into the managed care platform, adhering to UM policies and procedures. 5. Assists in the coordination… more
- CVS Health (Austin, TX)
- …compassionate. And we do it all with heart, each and every day. **Position Summary** The Manager of Prior Authorization oversees the daily operations of the ... prior authorization team, ensuring timely and accurate processing of ...United States. **Key Responsibilities:** + Lead and manage the prior authorization team, including hiring, training, scheduling,… more
- Community Based Care of Brevard, Inc. (Orlando, FL)
- Salary: $65,000/year Position Summary: The UM Program Manager provides oversight and management of service authorization data validation, reporting and trend ... provider invoices, reviews line-by-line entries, and submits to finance for payment. The UM Program Manager reconciles ARGOS Dependency Cases to FSFN for… more
- Integra Partners (Troy, MI)
- The Utilization Management ( UM ) Coordinator Supervisor oversees the day-to-day operations and performance of the UM Coordinator team. This position ensures that ... teamwork across the department. Salary: $65,000/annual JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES UM Coordinator Supervisor responsibilities include but are not limited… more
- Fallon Health (Worcester, MA)
- …Twitter and LinkedIn. **Brief Summary of Purpose:** Under the direction of the Manager of Prior Authorization , communicates with contracted and ... non-contracted facilities/agencies/providers to collect pertinent prior authorization request data and disseminates information to the Authorization … more
- Molina Healthcare (Everett, WA)
- …family include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... medications safety and medication use policies). **KNOWLEDGE/SKILLS/ABILITIES** The Pharmacist, UM will be responsible for reviewing coverage determinations and… more
- LA Care Health Plan (Los Angeles, CA)
- …Preferred: Experience in Medi-Cal managed care. 1 year of experience in UM / Prior Authorization . Skills Required: Demonstrated proficiency in Medical ... support the safety net required to achieve that purpose. Job Summary The Authorization Technician II supports the Utilization Management ( UM ) Specialist by… more
- Integra Partners (Troy, MI)
- …Take accountability for overall team performance, escalating issues as needed to the UM Clinical Manager . + Ensure compliance with all regulatory, contractual, ... The Utilization Management ( UM ) Nurse Supervisor is responsible for providing direct leadership and oversight to the UM nursing team. This role ensures team… more
- Commonwealth Care Alliance (Boston, MA)
- …Director of Utilization Management * Oversees clinical decision review for services requiring prior authorization in a variety of clinical areas, including but ... (must have): * Expertise in managing utilization review processes including prior authorization , concurrent and retrospective reviews * Demonstrated ability… more
- Sharp HealthCare (San Diego, CA)
- …encompasses a patient centered care management approach that includes referral management, prior authorization , Case Management and Disease Care Management and ... Healthcare Quality (CPHQ) - National Association for Healthcare Quality; Certified Case Manager (CCM) - Commission for Case Manager Certification **Hours** **:**… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …within a managed care setting including a high-level understanding of prior authorization processes including inpatient/concurrent reviews, outpatient, and ... About The Role The Manager , Utilization Management ( UM ) will manage...in Microsoft Word, Excel, and Outlook. Preferred Qualifications + Prior Experience with leadership including Hiring, WFM, Staff Performance.… more
- Whidbey General Hospital (Coupeville, WA)
- …right care at the right time-we'd love to meet you! The RN - Care Manager is a health care professional with experience and background to assure compliance with CMS ... Utilization Review and Discharge Planning. The RN - Care Manager will lead an assessment to identify the patient's...accordance with WhidbeyHealth policies, as well as monitors for authorization by the physician. + Complies with all documentation… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …division. + Serves as the primary contact for providers regarding authorization , information requests, claim inquiries and benefits. Provides triage assistance to ... and assists in handling member and provider correspondence related to authorization detail, disease conditions and/or care management program services. Assures… more
- Humana (Indianapolis, IN)
- …pharmacy benefits manager (PBM) activities, including the establishment of prior authorization , clinical appropriateness of use; consultations and clinical ... skills with prior experience leading teams focusing on quality management, UM , discharge planning and/or home health or rehab + Must reside in Illinois,… more
- Republic Airways (Indianapolis, IN)
- …Administrator responsible for overseeing its Airman Certification Organizational Designation Authorization (AC ODA) program. This role ensures compliance with FAA ... **ODA Program Oversight** + Serve as the ODA Administrator per FAA authorization , with full accountability for the structure, integrity, and compliance of the… more
- Elevance Health (Columbus, GA)
- …Management Representative I** will be responsible for coordinating cases for precertification and prior authorization review. **How you will make an impact:** + ... eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization , and post service requests. + Refers cases… more
- Elevance Health (Cincinnati, OH)
- …provide an equivalent background. **Preferred Skills, Capabilities, and Experiences:** + Prior Elevance Health experience strongly preferred. + Prefer the following ... system knowledge: EDI/EDINET; SQL; JIRA; FACETS (CENTRAL/GBD); BlueSquare, WEBSTRAT; Authorization Overwrite Tool (AO Tool) .Net UI; Claims Workstation Pega UI. +… more
