- CVS Health (Hartford, CT)
- …appropriate and timely utilization management activities for day-to-day operations, ie prior authorization , concurrent review, peer-to-peer and appeal reviews ... as determined by the plan leadership for NCQA and audits.* Lead the Medicaid markets national SAI ideation, development, and implementation.* Assist in other… more
- Elevance Health (Altamonte Springs, FL)
- …or ask you for payment as part of consideration for employment. **Pharmacy Prior Authorization Representative- BioPlus Specialty Pharmacy** + Job Family: CUS > ... **How you will make an impact:** + Reviews accuracy and completeness of prior authorization information requested and ensures supporting documents are present… more
- Elevance Health (Las Vegas, NV)
- …a check, or ask you for payment as part of consideration for employment. ** Prior Authorization Representative II - Las Vegas, NV - BioPlus Specialty Pharmacy** ... include, but are not limited to: + Reviews accuracy and completeness of prior authorization information requested and ensures supporting documents are present… more
- Rush University Medical Center (Chicago, IL)
- …Lead is responsible for obtaining and resolving referral, precertification, and/or prior authorization to support insurance specific plan requirements for all ... origin, disability, veteran status, and other legally protected characteristics.** **Position** Pre Authorization Lead **Location** US:IL:Chicago **Req ID** 6126 more
- Elevance Health (Plano, TX)
- …**How you will make an impact:** + Reviews accuracy and completeness of prior authorization information requested and ensures supporting documents are present ... prior authorizations/appeals. + Document insurance company interactions and all prior authorization information in system. + Reviews insurance denials and… more
- Humana (Columbus, OH)
- …to: identifying ways to reduce waste in key clinical categories, optimizing prior authorization requirements to streamline processes for providers, ensuring ... experience working in a utilization management role (eg, clinical policy development, prior authorization requirement definition, prior authorization … more
- Humana (Columbus, OH)
- …or more years of experience as a senior developer in large IT projects + Prior project lead experience + Must be passionate about contributing to an organization ... part of our caring community and help us put health first** The Lead Consumer Identity and Access Management Architect designs and develops IT applications… more
- Indian Health Service (Phoenix, AZ)
- …resources. Experience also includes, completion of patient admissions forms and obtaining prior authorization and approvals for billing alternate resources and ... Medical Center, located in Phoenix, Arizona. This position is a Lead Contact Representative, performs registration, admission, and benefits coordination services to… more
- State of Nevada (NV)
- …service, treatment, equipment or supplies are medically necessary and in compliance with Medicaid criteria prior to approving or denying requests. Review records ... participate in periodic reviews of facilities providing care to Medicaid eligible clients to validate and ensure adequacy of...at this level may intermittently serve as the project lead of a case management team, function as coordinator… more
- Humana (Richmond, VA)
- …psychopharmacology pharmacy benefits manager (PBM) activities, including the establishment of prior authorization , clinical appropriateness of use, and step ... will oversee our behavioral health (BH) clinical program for Medicaid members in Virginia. They will collaborate closely with...Director will be based in Virginia and will also lead the development of new products and services in… more
- Surgery Care Affiliates (Lubbock, TX)
- …aligning incentives to support growth and transition to value-based care. + We lead the industry in value-based payment solutions through our Global 1 bundled ... individual payer websites to obtain eligibility, benefits and/or pre-certs and authorization information. + Enter the patient insurance information into patient… more
- Kepro (Richmond, VA)
- …care, or personal care is required. + Minimum of one year UR and/or Prior Authorization or related experience. + Knowledge of standards of practice related ... nurse: reviews requests for medical treatments, services, or procedures for Medicaid fee-for-service services. Pre- authorization reviews require nurses to… more
- Truman Medical Centers (Kansas City, MO)
- …for special projects. They will ask key questions to help facilitate the prior authorization and scheduling process for specified procedures and Admission ... all financial and insurance information, obtaining appropriate pre-certification and authorization , collecting copays and deductibles, completes all authorization… more
- Fallon Health (Worcester, MA)
- …to be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid , and PACE- in the region. **Brief summary of purpose:** The ... processes and workflows, network development, contract management, claims, billing, and authorization assistance. This position requires regular travel to all Summit… more
- J&J Family of Companies (Gaithersburg, MD)
- …billing + Reimbursement or relevant managed care experience (revenue cycle, buy-and-bill, prior authorization , coding, and appeals processes) + Ability to ... + Immunology disease state experience + Advanced degree and/or relevant certifications in prior authorization and/or billing and coding + Strong market access… more
- Waystar (Atlanta, GA)
- …maintaining the feature backlog, and coordinating releases **WHAT YOU'LL NEED** + Experience with prior authorization + Experience with Smart on FHIR Apps and Da ... products and the natural instincts for making decisions that lead to highly useable software. This professional self-starter will...Vinci Prior Authorization Support, including the Coverage Requirements… more
- J&J Family of Companies (Raleigh, NC)
- …billing. + Reimbursement or relevant managed care experience (revenue cycle, buy-and-bill, prior authorization , coding, and appeals processes). + Ability to ... + Oncology disease state experience + Advanced degree and/or relevant certifications in prior authorization and/or billing and coding. + Strong market access… more
- J&J Family of Companies (OH)
- …billing * Reimbursement or relevant managed care experience (revenue cycle, buy-and-bill, prior authorization , coding, and appeals processes) * Ability to ... * Oncology disease state experience * Advanced degree and/or relevant certifications in prior authorization and/or billing and coding * Strong market access… more
- Commonwealth of Pennsylvania (PA)
- …strong analytical skills? Do you have a current knowledge of Center for Medicaid Services (CMS) regulations? The Department of Military and Veterans Affairs (DMVA), ... or quality assurance capacity. Special Requirements: + All positions require active authorization to practice as a Registered Nurse in Pennsylvania. + All employees… more
- Dignity Health (Bakersfield, CA)
- …- Preferred 5-7 years of experience in combination of utilization management prior authorization or acute/sub-acute care experience. - Understanding of ... will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health's Medicaid population health care… more