- University of Miami (Miami, FL)
- …CORE FUNCTIONS: + Adhere and perform timely prospective review for services requiring prior authorization as well as timely concurrent review for continuation of ... conducts initial, concurrent and retrospective chart reviews for clinical utilization and authorization . The Utilization Review Case Manager coordinates with the… more
- University of Miami (Miami, FL)
- …Case Manager RN - Full Time The University of Miami is currently seeking a Prior Authorization Nurse Case Manager. The incumbent purose is to conduct ... + Adhere and perform timely prospective reviews for services requiring prior authorization + Follows the authorization process using established criteria… more
- Blue KC (KS)
- …available resources to promote optimal, cost-effective outcomes. Transplant only: Provides prior authorization for, coordinates, and individually manages all ... work appropriately. Additional duties for Transplant only: + Provides prior authorization of the transplant and manages...medical policy. Opens case and follows NCQA case management standards. Documents transplant authorization , issues… more
- Hackensack Meridian Health (Hackensack, NJ)
- …/Radiation Oncology services in the HMH Health care system. This pertains to Prior Authorization for Oncology services, as well as various specialized ... portals where clinical data is submitted to substantiate the request for prior approvals for oncology services. **Education, Knowledge, Skills and Abilities… more
- MD Anderson Cancer Center (League City, TX)
- …At least two years of experience as Advanced Practice Provider, in General Oncology . Prior Thoracic/Head & Neck Medical Oncology experience. *LICENSURE ... the APP Manager. Coordination of tumor board conferences: Compiles case study data discussed at tumor board meetings. Reviews...years of experience as Advanced Practice Provider, in General Oncology . Prior Thoracic/Head & Neck Medical … more
- Astellas Pharma (South San Francisco, CA)
- …in payer coverage, healthcare payment models, and utilization management criteria (ie Prior Authorization , Step Edits, other forms of precertification), this ... **ARM - Partner, US Field Access & Reimbursement - Oncology - California** This position covers the state of...experience in leading access / reimbursement strategy or active case management + Understanding of the complexities of buy… more
- MD Anderson Cancer Center (Houston, TX)
- …to comply with institutional standards, initiatives, and guidelines (ABN's, prior authorization requirements, reimbursement optimization, formulary management, ... learning experiences. * Effectively precepts other trainee-required experiences including oncology forum, research projects, grand rounds, MUEs, etc. * Collaborates… more
- Saint Francis Health System (OK)
- …II ensures accuracy of insurance information and obtains prior authorization and predetermination requirements for non- oncology infusions, oncology ... National Comprehensive Cancer Network (NCCN) guidelines, medical necessity reviews, authorization submissions and follow-up care. The Authorization Specialist… more
- Methodist Health System (Dallas, TX)
- …professional responsible for verification of medical coverage, along with notification, prior authorization , and/or pre-determination of healthcare benefits for ... initiate pre- authorization and resolve issues that arise during the prior authorizations process. Supports and promotes the vision, mission, and strategic plans… more
- Cardinal Health (Nashville, TN)
- …management specialists simplify and optimize the practice's revenue cycle, from prior authorization through billing and collections. **Job Description** The ... **_What Benefits Eligibility and Authorization (RCM) contributes to Cardinal Health_** Practice Operations...such as deductible, out of pocket, copay and coinsurance prior to services rendered. + Verify if any … more
- Rush University Medical Center (Chicago, IL)
- …site of care. c. Assist in assessing insurance coverage and assist in prior authorization for medications (when necessary) in advance of discharge. Other ... Hematology/ Oncology * Board of Pharmaceutical Specialties Board Certification Board of Oncology Pharmacy Specialty Certification (BCOP) prior to or within 18… more
- Walmart (Orlando, FL)
- …adherence by addressing barriers and coordinating with prescribers, pharmacists, and prior authorization teams. + Monitor patient health status, assess ... in Orlando, FL, and make a meaningful impact in oncology care. As an Oncology Certified Nurse...+ Provide telephonic/video patient education, injection training, and ongoing case management for oncology therapies. + Support… more
- Rush University Medical Center (Chicago, IL)
- …activities and processes include but are not limited to completing prior authorizations for oncology specialty medications, providing insurance-related ... in accordance with Rush policies and procedures. **Responsibilities** * Completes prior authorizations for Oncology Specialty medications utilizing all resources… more
- Amgen (Baltimore, MD)
- …on TEPEZZA coverage based on their benefits and the steps needed to gain prior authorization to ensure understanding of the process for medication access + ... upon patient enrollment on coverage for AMGEN rare disease therapies, common prior authorization requirements, and coding and billings requirements + Provide… more
- AbbVie (North Chicago, IL)
- …groups to develop creative solutions to challenging patient access issues regarding prior authorization , and denied coverage requests to ensure patient care. ... of experience in the healthcare industry with knowledge in reimbursement, billing, prior authorization , appeals, and specialty pharmacy operations + 1-2 years… more
- Providence (OR)
- …of Outpatient Care) + Utilization Management Experience (EX. Concurrent Review, Prior Authorization , Medical Audits, Appeals or Delegation) + Experience ... Coordinator RN, Medicare / Medicaid who will:** + Provide care coordination, case management and care management services to Providence Health Plans(PHP) members +… more
- Avera (Sioux Falls, SD)
- …government programs. A successful advocate will communicate with patients, families, case managers, and providers to assess care plans and corresponding coverage ... applications for drug assistance. Provide accurate cost estimate details to patients prior to appointments. + Discuss benefits and other financial concerns with… more
- Sanford Health (Fargo, ND)
- …**Weekly Hours:** 40.00 **Salary Range:** $27.50 - $44.00 **Department Details** The Oncology Research team is looking for a Registered Nurse Coordinator! This full ... and screenings. What We're Looking For: * Active Registered Nurse * Prior research experience (preferred) * A collaborative, patient-centered mindset What We Offer:… more
- MD Anderson Cancer Center (Houston, TX)
- …to comply with institutional standards, initiatives, and guidelines (ABN's, prior authorization requirements, reimbursement optimization, formulary management, ... learning experiences. * Effectively precepts other trainee-required experiences including oncology forum, research projects, grand rounds, MUEs, etc. * Collaborates… more
- Rush University Medical Center (Chicago, IL)
- …* Three years of medical office experience. * Experience obtaining prior authorizations & knowledge of insurance authorization processes. **Responsibilities:** ... Unit: Rush Medical Center Hospital: Rush University Medical Center Department: Surgical Oncology PBC **Work Type:** Full Time (Total FTE between 0.9 and 1.0)… more