- CVS Health (Baton Rouge, LA)
- …with heart, each and every day. **Position Summary** The Utilization Management Manager of Prior Authorization oversees a team of clinical professionals ... + Lead, coach, and develop a multidisciplinary team responsible for utilization review, prior authorization , and case management functions. + Monitor team… more
- University of Miami (Miami, FL)
- …initial, concurrent and retrospective chart reviews for clinical utilization and authorization . The Utilization Review Case Manager coordinates with the ... Operations has an exciting opportunity for a full time Utilization Review Case Manager to work to...Adhere and perform timely prospective review for services requiring prior authorization as well as timely concurrent… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a* Utilization Review Manager * to join ourTransitional Care Team.This is a full-time role and will be required to work ... ) required or completed within three years of hire **Title:** * Manager - Utilization Review* **Location:** *MN-Minneapolis-Downtown Campus* **Requisition ID:**… more
- Fallon Health (Worcester, MA)
- …Registered Nurse in a clinical setting required. * 2 years' experience as a Utilization Management/ Prior Authorization nurse in a managed care payer ... **This is 3 months temporary contract position for a Prior Authorization RN.** **About us:** Fallon Health...Keeps records and submits reports as assigned by the Manager * Refers high-risk cases to the appropriate FH… more
- Fallon Health (Worcester, MA)
- …expectations. The FH Authorization Coordinator serves to administer the FH prior authorization process as outlined in the Plan Member Handbook/Evidence of ... when the authorization meets the criteria listed in the appropriate Prior Authorization Protocol, authorizations not meeting protocol parameters are prepared… more
- University of Rochester (Rochester, NY)
- …activities as defined by NYS Laws and Regulations. The Pharmacy Medication Utilization and Inventory Compliance Manager has direct supervision and management ... medication inventory management locations, and is intended to be a 'line manager ' level of responsibility, covering shifts typical of their team while utilizing… more
- Evolent (Annapolis, MD)
- …at Evolent will serve as a point of contact for processing prior authorization requests in accordance with departmental policies, regulatory requirements, ... + Reviewing internal workflows and policies to determine if submitted requests require a prior authorization review or redirect as required. + Entering data into… more
- Elevance Health (Seven Hills, OH)
- …**Build the Possibilities. Make an Extraordinary Impact.** **Title** : Clinical Pharmacist ( Prior Authorization ) **Location(s):** + Indianapolis, IN + Mason, OH ... law._** The **Clinical Pharmacist** is responsible for managing the selection and utilization of pharmaceuticals and supports core clinical programs such as DUR, DIS… more
- Elevance Health (Costa Mesa, CA)
- … Management Representative I** is responsible for coordinating cases for precertification and prior authorization review. **How you will make an impact:** + ... ** Utilization Management Representative I** **Location** : This role...provides authorization for inpatient admission, outpatient precertification, prior authorization , and post service requests. +… more
- Elevance Health (Miami, FL)
- …eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization , and post service requests. + Obtains intake ... ** Utilization Management Representative II** **Virtual:** This role enables...to screen basic and complex requests for precertification and/or prior authorization . + Verifies benefits and/or eligibility… more
- Elevance Health (Durham, NC)
- …Management Representative I** will be responsible for coordinating cases for precertification and prior authorization review. **How you will make an impact:** + ... **Title: Utilization Management Representative I** **Location:** **Winston Salem,...provides authorization for inpatient admission, outpatient precertification, prior authorization , and post service requests. +… more
- Elevance Health (Columbus, GA)
- … Management Representative III** is responsible for coordinating cases for precertification and prior authorization review. **How you will make an impact:** + ... **Title: Utilization Management Representative III** **Virtual:** This role enables...contract and benefit eligibility for requested continuing pre-certification and prior authorization of inpatient and outpatient services… more
- US Tech Solutions (Columbia, SC)
- …but could be extended. + A typical day would like in this role: Process prior authorization requests for Medicare Advantage line of business. + Team: Fast paced, ... Interactive team works with multiple applications to process authorization and appeals requests using Medicare criteria. **Responsibilities:** + Reviews and… more
- Healthfirst (NY)
- …leadership to UM leaders and teams executing department functions including prior authorizations, concurrent reviews, and service requests + Develop strong ... to maintain and improve department performance + Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement + Lead… more
- Henry Ford Health System (Troy, MI)
- …processing system, development of new benefit designs and programs, organizing the prior authorization process and management of the various vendor/customer ... GENERAL SUMMARY: Reports to the Manager of Pharmacy Benefits and other delegated pharmacist....Additional Information + Organization: Community Care Services + Department: Pharmacy- Utilization Mgmt + Shift: Day Job + Union Code:… more
- Humana (Frankfort, KY)
- …a part of our caring community and help us put health first** The Pre- Authorization Nurse 2 reviews prior authorization requests for appropriate care ... to Tier III care management as needed. * Perform prior authorization reviews according to established HUMANA...Coordinate cases with and refer to tier III Care Manager and Disease Management Programs as appropriate. **Use your… more
- UNC Health Care (Goldsboro, NC)
- …6. Escalate matters/scheduled accounts that require attention to Pre-Arrival Team Lead/ Manager . 7. Notify Utilization Review & Case Management regarding ... **Description** Summary: The Pre- Arrival Authorization Specialist I will serve patients/customers and physician...and physician offices by obtaining authorizations from insurance payers prior to services being scheduled or rendered at UNC… more
- Sharp HealthCare (San Diego, CA)
- …referrals for care and services are directed to appropriate network providers, and obtains prior authorization for in network and out of network services as ... Day **FTE** 1 **Shift Start Time** **Shift End Time** Accredited Case Manager (ACM) - American Case Management Association (ACMA); Bachelor's Degree in Nursing;… more
- Sharp HealthCare (San Diego, CA)
- …referrals for care and services are directed to appropriate network providers, and obtains prior authorization for in network and out of network services as ... **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered… more
- Elevance Health (Cincinnati, OH)
- …an impact:** + Oversees pharmacist and pharmacy intern associates developing and configuring prior authorization decision trees in the PA workflow tool. + ... **Title:** Manager , Pharmacy Clinical Operations (Clinical Configuration) **Location(s):** Mason,...Oversees associate performance and quality assurance of prior authorization decision trees within the PA… more