- University of Miami (Miami, FL)
- …CORE FUNCTIONS: + Adhere and perform timely prospective review for services requiring prior authorization as well as timely concurrent review for continuation of ... conducts initial, concurrent and retrospective chart reviews for clinical utilization and authorization . The Utilization Review Case Manager coordinates with the… more
- University of Southern California (Los Angeles, CA)
- …outlined below.The cancer coordinator/navigator is a professional Registered Nurse with oncology specific clinical knowledge who a) participates in the care of ... and treatment stress The nurse navigator screens new patients referred to the Oncology services to ensure patients are directed to the correct services and to… more
- MD Anderson Cancer Center (Houston, TX)
- …to comply with institutional standards, initiatives, and guidelines (ABN's, prior authorization requirements, reimbursement optimization, formulary management, ... medication therapy, ensure safe and effective drug use, and contribute to cutting-edge oncology practices. *At MD Anderson, we offer careers built on care, growth,… more
- Blue KC (Workman, MN)
- …available resources to promote optimal, cost-effective outcomes. Transplant only: Provides prior authorization for, coordinates, and individually manages all ... work appropriately. Additional duties for Transplant only: + Provides prior authorization of the transplant and manages...medical policy. Opens case and follows NCQA case management standards. Documents transplant authorization , issues… more
- Rush University Medical Center (Chicago, IL)
- …site of care. c. Assist in assessing insurance coverage and assist in prior authorization for medications (when necessary) in advance of discharge. Other ... Hematology/ Oncology * Board of Pharmaceutical Specialties Board Certification Board of Oncology Pharmacy Specialty Certification (BCOP) prior to or within 18… more
- Amgen (Philadelphia, PA)
- …on KRYSTEXXA coverage based on their benefits and the steps needed to gain prior authorization to ensure understanding of the process for medication access + ... upon patient enrollment on coverage for Horizon rare disease therapies, common prior authorization requirements, and coding and billings requirements + Provide… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …of managed care policies and medical terminology. * Knowledge and understanding of prior authorization and billing practices. * Knowledge and understanding of ... all required referrals/authorizations for each phase of the transplant and IEC prior to the services performed and is responsible for effectively communicating the… more
- AbbVie (North Chicago, IL)
- …groups to develop creative solutions to challenging patient access issues regarding prior authorization , and denied coverage requests to ensure patient care. ... of experience in the healthcare industry with knowledge in reimbursement, billing, prior authorization , appeals, and specialty pharmacy operations + 1-2 years… more
- Army National Guard Units (VA)
- …efficiency and to reduce or eliminate future hazardous conditions. 3. Manages the Case Management Program. In coordination with the US Department of Labor (DOL) ... Liaison, and the Director, Human Resources, serves as the local OHN Case Manager Consultant for ensuring development, evaluation, implementation and monitoring a… more
- Avera (Sioux Falls, SD)
- …government programs. A successful advocate will communicate with patients, families, case managers, and providers to assess care plans and corresponding coverage ... applications for drug assistance. Provide accurate cost estimate details to patients prior to appointments. + Discuss benefits and other financial concerns with… more
- Option Care Health (Olympia, WA)
- …Care and externally with customers (ex. medical director, head of case management, executive c-suite individuals). Travel Requirements: (if required) Willing to ... at least 7 years of pharmaceutical or healthcare sales experience. + Prior experience selling strategic solutions (specialty products and/or services) to hospitals,… more
- Option Care Health (Florham Park, NJ)
- …Care and externally with customers (ex. medical director, head of case management, executive c-suite individuals). **Travel Requirements** **: (if** **required)** + ... at least 4 years of pharmaceutical or healthcare sales experience. + Prior experience selling strategic solutions (specialty products and/or services) to hospitals,… more
- Beth Israel Lahey Health (Cambridge, MA)
- …related field. - Prior nursing experience in urology, surgical care, or oncology is a plus. Skills and Abilities: - Strong clinical assessment and diagnostic ... necessary and ensure seamless care transitions. - Participate in case reviews and contribute to treatment planning discussions. -...the MA DPH-DCP and Federal DEA + MA Board authorization to practice as an APRN NRSG + American… more
- Option Care Health (Chicago, IL)
- …Care and externally with customers (ex. medical director, head of case management, executive c-suite individuals). **Preferred Qualifications** + MBA in Business ... at least 4 years of pharmaceutical or healthcare sales experience. + Prior experience selling strategic solutions (specialty products and/or services) to hospitals,… more