- Jazz Pharmaceuticals (New York, NY)
- …targeted objectives and meet established MBO's and goals. Provider and account interface, prior authorization and coding education, as well as case management ... to support patient access needs.Educate and ensure providers understand payer prior authorization requirements, appeals process, clinical criteria, and… more
- 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
- 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
- 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
- Healthfirst (NY)
- …Creates and integrates new workflow improvement strategies and/or resources. + Reviews prior authorization requests and units for medications requested under the ... The Lead Pharmacy Technician position is a supervisory position...as well as requests for information sheets. + Performs prior authorization reviews as set forth by… 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
- Trinity Health (Livonia, MI)
- …the team workload to ensure all services are financially cleared five (5) days prior to the date of service, and Urgent Admission accounts are financially cleared ... after all efforts are exhausted. Refers cases to RHM Medicaid Vendor and Benefit Advocate for resolution when patients...seen. Reviews and responds to denials related to no referral/ authorization , wrong insurance billed, and not eligible date of… 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
- 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
- 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
- Surgery Care Affiliates (Mokena, IL)
- …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
- Waystar (Lehi, UT)
- …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
- 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
- CommonSpirit Health Mountain Region (Pueblo, CO)
- …serving some of the most diverse communities across the nation, letting humankindness lead the way. Overview: As "the champion of first impressions" our valued ... operations, customer service and have plenty of opportunity to lead and guide change. You'll be seen as a...or patient representative and collect the outstanding patient portion prior to or at the point of service. Maintains… more
- BeneLynk (Sunrise, FL)
- …We are actively seeking an experienced Contact Center Supervisor to supervise and lead their direct report Team Leaders and their teams that conduct telephonic ... identify eligibility and assist with enrollment in Medicare Savings Programs/ Medicaid . + Coach. As a supervisor, you have a...work environment and atmosphere. + Answer agent and team lead questions regarding best practices or difficult calls. +… more
- CVS Health (Columbus, OH)
- …Components: * Utilization management - The medical director will perform concurrent and prior authorization reviews with peer to peer coverage of denials. * ... medical director will participate in and be able to lead daily rounds. Required Qualifications: Minimum 3-5 years of...+ years of experience in managed care (Medicare and/or Medicaid ) Experience with managed care (Medicare and Medicaid… more
- Billings Clinic (Billings, MT)
- …must complete several pre-employment requirements prior to starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) ... and data analysis techniques. Accurately fills requests for transcribed documents or prior patient medical records using available systems such as CIS, ChartLocator,… more
