- Luke Staffing (Yigo, GU)
- …TRICARE benefit for approval. + Ensures Line of Duty paperwork is on file prior to authorization . + Verify eligibility of beneficiaries using Defense Eligibility ... **NURSE - REFERRAL MANAGEMENT** **SITE OF SERVICE:** + Anderson Air...communication between beneficiaries, team members, internal staff and providers, network /outside providers and ancillary health care workers. + Reviews… more
- ALPCO (Denver, CO)
- …with OEM field service organizations and IT departments for integrated system/ network setup. Maintain field service inventory, records, and documentation. Contribute ... experience diagnosing and repairing electromechanical or electronic laboratory equipment. Prior applications, field applications scientist (FAS), or MSL experience… more
- LaSante Health Center (Brooklyn, NY)
- LaSante Health Center is seeking a Referrals and Prior Authorization Specialist to join our team. The ideal candidate will help ensure patients have seamless ... to medications, diagnostic imaging, and specialty care by managing prior authorization requests for insurance and guiding... requests for insurance and guiding patients through the referral process. This position offers the opportunity to be… more
- St. Luke's University Health Network (Bethlehem, PA)
- …Acquire and submit all necessary clinical information to insurance company needed to obtain prior authorization in a timely fashion + Obtains knowledge of any ... we serve, regardless of a patient's ability to pay for health care. The Referral Scheduling Specialist is a liaison between the providers and the patients. They are… more
- Health Advocates Network (Tucson, AZ)
- …or healthcare call center experience required - Recent medical referrals, prior authorization , and insurance verification experience required - Familiarity ... and personable Referral Clerks to join their team! Health Advocates Network , Inc. is an equal opportunity employer. All qualified applicants shall receive… more
- Tufts Medicine (Stoneham, MA)
- …under supervision. An entry level role that typically requires little to no prior knowledge or experience, work is routine or follows standard procedures, work is ... under supervision. An entry level role that typically requires little to no prior knowledge or experience, work is routine or follows standard procedures, work is… more
- Pine Rest Christian Mental Health Services (Grand Rapids, MI)
- …behavioral health system in the country, our 220-acre main campus, and our network of clinical sites across Michigan. We are a tight-knit community of healers ... incredible work. What Will You Do?As an Assessment & Referral Clinician at Pine Rest, you'll be part of...including interfacing with insurance and managed care companies for authorization . + Refer patients to outpatient services, either within… more
- Hartford HealthCare (North Haven, CT)
- …different specialties. *_Job Description_* Under the direction of the Manager, a Prior Authorization Specialist performs all clerical duties required to obtain ... you to become part of Connecticut's most comprehensive healthcare network . Hartford HealthCare Medical Group is one of the...clinical departments, as applicable. . Monitors and reviews the prior authorization work queue daily to verify… more
- Pine Rest Christian Mental Health Services (Grand Rapids, MI)
- …behavioral health system in the country, our 220-acre main campus, and our network of clinical sites across Michigan. We are a tight-knit community of healers ... work. What Will you Do? As an Assessment & Referral Registered Nurse (ARRN) at Pine Rest, you'll be...including interfacing with insurance and managed care companies for authorization . + Refer patients to outpatient services within or… more
- St. Luke's University Health Network (Allentown, PA)
- …needs change, the services may be performed at any level within the Network 's continuum of services and/or sites. JOB DUTIES AND RESPONSIBILITIES: + Demonstrates ... care. + Arranges for community services (including short and long-term placement) prior to discharge to meet patient's needs with recognition and documentation of… more
- Bassett Healthcare (Clinton, NY)
- …a go to person for coworkers. + Obtains prior approval or prior authorization as needed. Communicates referral appointment and appointment instructions ... point of contact for patients within the Bassett Healthcare Network . This is a key role in the patient...Medicare regulations. + Obtains prior approval or prior authorization as needed. Communicates referral… more
- Bassett Healthcare (Cooperstown, NY)
- …Patient Access Review Sessions (PARS) + Obtains prior approval or prior authorization as needed. Communicates referral appointment and appointment ... point of contact for patients within the Bassett Healthcare Network . This is a key role in the patient...urgent referrals same day. Processes electronic or written routine referral requests within 24-72 hours + In regards to… more
- Community Health Systems (Laredo, TX)
- …follows up with the insurance company until there is resolution of the prior authorization request - an approval, redirection, or denial. All activity ... linked to the referral requested. + Validates continuity of care and network integrity based on service line availability for quality patient care. + Sends all… more
- Humana (Indianapolis, IN)
- …assisting providers in determining whether a specific service for a member requires prior authorization or referral , ensuring compliance with established ... medical record and documentation programs + Experience with Utilization Review and/or Prior Authorization , preferably within a managed care organization +… more
- Logan Health (Kalispell, MT)
- …benefit statuses as needed. + Determine and process pre-certification or referral requirements per protocol. + Communicate with providers regarding out-of- network ... barriers and document accordingly. + Estimate and collect patient liability prior to service, following cash management policies. + Maximize collection of co-pays… more
- Actalent (Los Angeles, CA)
- …+ Conduct clinical reviews, analyses, recommendations, decisions, and documentation of prior authorization requests, medical exception requests, and appeal ... drug information support and research clinical literature documentation to support prior authorization decisions. + Prepare Pharmacy and Therapeutics meeting… more
- Veterans Affairs, Veterans Health Administration (Boise, ID)
- …health information in accordance with all laws and regulations governing authorization and disclosure of health information. Responsibilities Total Rewards of a ... nature. Incumbent is responsible for evaluating the adequacy of each completed authorization form. Screens each request for information to determine urgency and… more
- State of Connecticut, Department of Administrative Services (Hartford, CT)
- …+ 8:00am-4:30pm + Hybrid schedule The Role: + Oversee the claim and prior authorization review processes, dental regulations and procedure adherence, management ... with dental vendor to ensure the timely handling of prior authorization claim reviews; + Evaluate the...and changes from the Department to the vendors, provider network and community partners; + Conduct professional relations between… more
- Covenant Health Inc. (Knoxville, TN)
- …+ Verifies insurance coverage on each new referral taken. + Obtains a Prior Authorization and or Recertification when required by the insurance company. + ... Receives referrals and new orders on patients. Responsible for verification, prior authorization , and Recertification of insurance. Negotiates pricing with… more
- Covenant Health Inc. (Knoxville, TN)
- …of Covenant Health (http://www.covenanthealth.com) , our region's top-performing healthcare network . Position Summary: The Clinical Field Staff Supervisor (CFSS) ... success of providing by effectively facilitating the relationship between referral sources, patients, caregivers and employees. Recruiter: Madeline Fornadel ||… more
