- Kepro (AL)
- …to being a vital partner for health solutions in the public sector. Acentra seeks a Prior Authorization Reviewer to join our growing team. Job Summary: The ... Prior Authorization Reviewer : + Reviews...AM to 4:00 PM Central. ** ** This is a Remote position within the state of Alabama, where the selected candidate… more
- Commonwealth Care Alliance (Boston, MA)
- …and organizational determinations. **What You'll Be Doing:** + Conducts timely clinical decision review for services requiring prior authorization in a ... (UM) Reviewer is responsible for day-to-day timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization… more
- Kepro (Richmond, VA)
- …+ Strong clinical assessment and critical thinking skills. + 1+ year of Utilization Review (UR) and/or Prior Authorization or related work experience. + ... our growing team. Job Summary: Our Behavioral Health Clinical Reviewer RN/LCSW will use clinical expertise to review...with NCQA, URAC, and other regulatory standards. *Position is remote , but candidates must reside in and be licensed… more
- US Tech Solutions (Canton, MA)
- Remote position but will be required to go on...Coordinates the review process for services requiring prior authorization by . This includes matching the ... necessary for coverage determinations and prepares cases for Medical Director Review , including the procurement of Plan Benefit Documents and Medical Necessity… more
- Centene Corporation (Oklahoma City, OK)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service ... assess medical necessity of care of member + Escalates prior authorization requests to Medical Directors as...members + Provides feedback on opportunities to improve the authorization review process for members + Performs… 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 **Summary**...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)
- …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
- Fairview Health Services (St. Paul, MN)
- …computer systems, including Microsoft Office 365 **Preferred** **Experience** + Referrals and/or prior authorization experience + Epic experience + Knowledge of ... **Overview** This is a remote position under Revenue Cycle Management that is responsible for obtaining all medical necessity approvals for a patient's service… more
- Randstad US (Woodland Hills, CA)
- …8 AM - 5 PM education: High School Responsibilities + Supports the authorization review process by researching and documenting necessary medical information such ... of Randstad's has an immediate opening for an experienced Authorization Specialist. This is a remote role,... requests for services in accordance with the insurance prior authorization list and routes to the… more
- Corewell Health (Kentwood, MI)
- …or equivalent + 1 year of relevant experience in related field Preferred + Prior Authorization experience + Epic experience + Payor portal experience + Basic ... by way of obtaining accurate and timely authorizations. Crucial to obtaining an authorization is the ability to read and understand basic insurance information as… more
- CVS Health (Baton Rouge, LA)
- …+ 5+ years of clinical experience + 1+ year(s) of utilization management, concurrent review and/or prior authorization experience + 5+ years of equipment ... care more personal, convenient and affordable. Position Summary Fully remote role in Louisiana.Requires Monday-Friday: 8:00am-5:00pm CST shift. Weekend/holiday… more
- Molina Healthcare (Bronx, NY)
- …for Medicaid and Medicare.** **We are looking for a LPN or LVN Care Review Clinician with Prior Authorization experience. Experience with Utilization ... financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. + Processes… more
- Molina Healthcare (CA)
- …financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. + Processes ... **JOB TITLE: CARE REVIEW CLINICIAN INPATIENT REVIEW : REGISTERED...to work some weekends and holidays. This is a remote position and you may work from home. Please… more
- St. Luke's University Health Network (Allentown, PA)
- …patient class obtained prior to discharge, communicate back to PEC for re- authorization , as needed + Is a resource to the Coding department, SLPG practices, ... patient's ability to pay for health care. The Surgical Review Specialist prospectively reviews, validates, and audits procedure code...patient class is obtained for IP only Medicare cases prior to date of service + Ensure all IP… more
- The Cigna Group (Bloomfield, CT)
- …grid and provider status + Review customer coverage and benefits + Review authorization requests and make determinations on correct authorization process ... by collecting, interpreting and evaluating medical information received for authorization . The Pre-cert Specialist will communicate with internal and external… more
- PSEG (Salem County, NJ)
- …becoming qualified) as a SQR Reviewer and a 10CFR50.59 Evaluation preparer/ reviewer . **Preferred:** Prior experiences in large plant projects and/or Power ... hybrid roles that are a blend of onsite and remote work, remote local roles that are...safe, efficient, cost effective operation of the Salem Units. Review design and proposed license changes for compliance with… more
- Option Care Health (Springfield, IL)
- …insurance verification information and payer contracts and/or self-pay guidelines. Obtains initial authorization prior to admitting the patient for all services ... patient eligibility, coordinate benefits, run test claims, submit initial authorization and determine patient coverage/responsibility for services and testing and… more
- Houston Methodist (Houston, TX)
- …for patients receiving services and initiates the admission notification and authorization process in a timely manner. The Senior Insurance Verifier communicates ... ability to perform more complex processes related to insurance verification, authorization , and financial clearance. This position will also utilize effective… more
- RTX Corporation (Boston, MA)
- Date Posted: 2024-04-26 Country: United States of America Location: UT36: CA-MA - Corp Remote Location, Remote City, MA, 02108 USA Position Role Type: Hybrid RTX ... or devices to ensure spill procedures are in place prior to deployment. + Primary liaison to the Cloud...overall system integrity. + Leads the GSS Cloud Architecture Review Board and Change Control Board. + Coordinates with… more