- US Tech Solutions, Inc. (Columbia, SC)
- …2-4 PREFERRED/NICE TO HAVE skill sets/qualities: I would love to have someone with prior insurance/utilization review experience, but I know that is not very ... equipment to be prepared. . The position is fully remote after that. . Please list out the top...The nurse would work remotely from their home reviewing authorization requests from providers for home health visits or… more
- Spectraforce Technologies Inc (Atlanta, GA)
- …they are handled. Collect PA requirements, follow up with the insurance for prior authorization status, and communicate the results to the healthcare provider. ... Title: Patient Access Specialist Location: Remote Duration: 3+ month's Shift timings: 8:00 am...Billing and coding support. Claims assistance, tracking and submission. Prior authorization assistance and tracking. Coordination of… more
- Spectraforce Technologies Inc (Atlanta, GA)
- …to expedite patient access. Could include documenting and initiating prior authorization process, claims appeals, etc. Completes quality review of work as ... Title: Benefits Verification Specialist Location: Remote Duration: 3+ month's Working hours: 8:30am to...Collect PA requirements, follow up with the insurance for prior authorization status, and communicate the results… more
- Spectraforce Technologies Inc (Atlanta, GA)
- …on medical and prescription insurance coverage/ verification, claim billing, medication prior authorization and appeal filing, and alternate financial assistance ... Job Title: Insurance Analyst II Duration: 6 Months Location: ( Remote ) Shift Hours: The hours of operation are 7am-7pm CST. Are you comfortable working one of the… more
- Fallon Health (Worcester, MA)
- …us on Facebook, Twitter and LinkedIn. 3 days in the office ** Prior Authorization experience required** **Brief summary of purpose:** Performs all functions ... associated with completing tasks related to inpatient and prior authorization denial letters and special approval letters. This position serves as the subject… more
- University of Miami (Miami, FL)
- …compliance with medical advice. CORE FUNCTIONS: + Adhere and perform timely prospective review for services requiring prior authorization as well as ... System, Department of Utilization Management, has an exciting opportunity for an Utilization Review Case Manager to work remote . The incumbent conducts initial,… more
- Kepro (AR)
- …limited degree of supervision. Responsibilities include, but are not limited to + Review first-level Prior Authorization (PA) requests related to ... timely decision-making and adjudication of dental claims, referrals, and pre-authorizations. Prior authorization and post payment reviews leverage patient care… more
- The Cigna Group (Bloomfield, CT)
- …in Utilization Management. Handles moderately complex medical review , utilization review , credentialing/re-credentialing, quality assurance/improvement, ... for the following: + Laboratory molecular and genetic testing clinical case review activities. + Evaluate telephone, fax, or web requests for authorization… more
- Kepro (ND)
- …of North Dakota or a compact state license. + 1+ years of Utilization experience Review (UM) and/or Prior Authorization or related experience. + 3+ years ... join our growing team. Job Summary: Our Nurse Clinical Reviewer will use clinical expertise for the review...NCQA, URAC and other regulatory standards. Position is full-time remote as long as you have an active unrestricted… more
- Centene Corporation (New York, NY)
- …interdepartmental teams, to assess medical necessity of care of member + Escalates prior authorization requests to Medical Directors as appropriate to determine ... members + Provides feedback on opportunities to improve the authorization review process for members + Performs...plus holidays, and a flexible approach to work with remote , hybrid, field or office work schedules. Actual pay… more
- University of Michigan (Ann Arbor, MI)
- …+ Ability to meet and exceed departmental quality, production, and prior authorization standards. + Ability to review and resolve denials pertaining to ... Prior Authorization Specialist Apply Now **Job...and employees. + Ability to effectively work in a remote environment and connect via multiple communication channels (phone,… more
- CVS Health (Austin, TX)
- …plan/employer-agreed criteria within the designated service level agreements. - Evaluate and review all prior authorization requests and render coverage ... Specialty and Non-Specialty Pharmacy programs administered within the Commercial Prior Authorization and Case Review ...employee discount at all CVS stores. This is a remote role open to candidates within the United States.… more
- CVS Health (Austin, TX)
- … Prior remote experience - Case Management experience - Prior authorization experience - High production experience **Education** LVN/LPN Diploma ... pharmacists, other clinical colleagues, healthcare professionals and members. - Follow all prior authorization procedures to guarantee an accurate process on… more
- Humana (Cincinnati, OH)
- …a part of our caring community and help us put health first** The Pre- Authorization Nurse 2 reviews prior authorization requests for appropriate care ... approves services or forward requests to the appropriate stakeholder. The Pre- Authorization Nurse 2 work assignments are varied and frequently require interpretation… more
- Insight Global (Charlottesville, VA)
- …and Requirements Requirements: * High school Diploma or equivalent * 2 years of prior authorization experience * Epic experience Reliable computer and high speed ... Job Description *This is a remote job opportunity however you must sit in...speed internet. * Insight Global is seeking a Pre- Authorization specialist for a large hospital system in Virginia.… more
- Molina Healthcare (Riverside, CA)
- …benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina ... its members. + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional… more
- US Tech Solutions (May, OK)
- …other clinical colleagues, healthcare professionals and members. + * Follow all prior authorization procedures to guarantee an accurate process on each ... data entry, data management, and reporting. **Experience:** + * Review criteria-based prior authorizations following policy and... prior authorization . + * Train and mentor… more
- Molina Healthcare (Charleston, SC)
- …benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina ... its members. + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional… more
- Molina Healthcare (New York, NY)
- …who are eligible for Medicaid .** **We are looking for a RN Care Review Clinician with Prior Authorization experience. Candidates with Utilization Management ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
- Kepro (PA)
- …the efficiency of our review process. Your role involves meticulously preparing prior authorization cases for clinical review , streamlining operations to ... in facilitating our mission to provide timely and accurate review services. *Position is remote , but candidates...Prior experience in Quality Improvement (QI) or Utilization Review would be nice to have. Why us? We… more
