- Molina Healthcare (Bowling Green, KY)
- …regulations, NCQA guidelines, and CMS standards. + Provides coordination and processing of pharmacy prior authorization requests and/or appeals. + Explains ... those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs… more
- Highmark Health (Nashville, TN)
- …clearly defines the medical necessity of non-formulary and prior authorization medication exception requests. Interacts with pharmacy network providers to ... requests for drug authorizations or denials. + Review of prior authorization criteria for drug products. +...billing practices through paid clams review. + Participate as pharmacy representative in onsite member appeals and… more
- Intermountain Health (Nashville, TN)
- …to termination, at the hiring manager's discretion. **Preferred** + Prior Authorization processing preferred **Physical Requirements:** **Physical Requirements** ... **Job Description:** The Pharmacy Technician demonstrates consistent application of knowledge and...each essential duty satisfactorily. The requirements list must be representative of the knowledge, skills, minimum education, training, licensure,… more
- Cardinal Health (Nashville, TN)
- …and/or Medical Claims billing and Coding work experience + 1-2 years experience with Prior Authorization and Appeal submissions + Ability to work with high ... streamline patient onboarding, qualification and adherence. Our non-commercial specialty pharmacy is centralized at our custom-designed facility outside of Dallas,… more
- Cardinal Health (Nashville, TN)
- …and pharmacy insurance benefit practices, preferred + 1-2 years experience with Prior Authorization and Appeal submissions, preferred + Ability to work with ... streamline patient onboarding, qualification and adherence. Our non-commercial specialty pharmacy is centralized at our custom-designed facility outside of Dallas,… more
- Pfizer (Nashville, TN)
- …payer landscape, payer coverage and formulary change updates, payer policies (eg, prior authorization , step edits, specialty pharmacy coverage), Hub ... this matter, please do not hesitate to contact your Talent Acquisition representative . **EEO & Employment Eligibility** Pfizer is committed to equal opportunity in… more
- Cardinal Health (Nashville, TN)
- …and pharmacy insurance benefit practices, preferred + 1-2 years' experience with Prior Authorization and Appeal submissions, preferred + Ability to work with ... needs of the patient and/or program + Resolve patient's questions and any representative for the patient's concerns regarding status of their request for assistance… more
- Cardinal Health (Nashville, TN)
- …care and timely access to necessary services + Assist in obtaining insurance, prior authorization , and appeal requirements and outcomes + Help patients ... streamline patient onboarding, qualification and adherence. Our non-commercial specialty pharmacy is centralized at our custom-designed facility outside of Dallas,… more