- CVS Health (Nashville, TN)
- …Responsibilities - Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. - Applies medical necessity ... written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals . - Insures all compliance requirements are satisfied and all… more
- CVS Health (Nashville, TN)
- …and problems. + Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. + Applies medical necessity guidelines, ... written inquiries related to requests for pre-approval/pre-authorization, reconsiderations, or appeals . + Insures all compliance requirements are satisfied and all… more
- CVS Health (Franklin, TN)
- …Responsibilities:** + Possesses knowledge all Aetna health products available to the senior market. + Gives guidance with sales inquiries + Manages various software ... including insurance plan types, PBM and major medical benefits, prior authorizations and appeals processing. + Ability to work in a fast paced environment, handling… more
- Evolent (Nashville, TN)
- …Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your expertise in interventional cardiology to help ensure the ... of best practices. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations (peer to peer phone calls) with requesting physicians… more