- 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
- MD Anderson Cancer Center (Houston, TX)
- …to comply with institutional standards, initiatives, and guidelines (ABN's, prior authorization requirements, reimbursement optimization, formulary management, ... learning experiences. * Effectively precepts other trainee-required experiences including oncology forum, research projects, grand rounds, MUEs, etc. * Collaborates… more
- Hartford HealthCare (Bridgeport, CT)
- …and insurance requirements, ensuring all necessary paperwork and required tests needed prior to surgery are accurately completed, and clearly communicated pre- and ... and provides consistent documentation in EPIC to support the obtained insurance authorization . Communicates changes in payer and or federal regulatory guidelines to… more
- Cardinal Health (Nashville, TN)
- …management specialists simplify and optimize the practice's revenue cycle, from prior authorization through billing and collections. **Job Description** The ... **_What Benefits Eligibility and Authorization (RCM) contributes to Cardinal Health_** Practice Operations...such as deductible, out of pocket, copay and coinsurance prior to services rendered. + Verify if any … more
- University of Rochester (Rochester, NY)
- …data and ensures compliance to enterprise standards and referral and prior authorization guidelines. Communicates regularly with patients, families, clinical ... Subtype: Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 500223 Radiation Oncology SMH Work Shift: UR - Day (United States of America) Range: UR… 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
- Rush University Medical Center (Chicago, IL)
- …activities and processes include but are not limited to completing prior authorizations for oncology specialty medications, providing insurance-related ... in accordance with Rush policies and procedures. **Responsibilities** * Completes prior authorizations for Oncology Specialty medications utilizing all resources… more
- AbbVie (North Chicago, IL)
- …business model. Responsibilities + Supervise and oversee analysts responsible for prior authorization education and post-benefit verification follow up (Bridge, ... groups to develop creative solutions to challenging patient access issues regarding prior authorization and denied coverage requests to ensure patient care.… more
- Amgen (Newark, NJ)
- …on UPLIZNA 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
- AbbVie (San Juan, PR)
- …aspects, including formulary status, drug coverage criteria, prescription statuses, prior authorization processes, essential coding and reimbursement ... prescription gaps and documentation challenges to anticipate and/or optimize prior authorization requirements, coverage determination processes, and health… more
- Logan Health (Kalispell, MT)
- …patients, gather prior imaging and pathology when needed, and coordinate follow-up prior to case review. + Serve as a reassuring and knowledgeable resource ... support and patient advocacy in a high-touch role Preferred Qualifications + Prior experience in breast imaging, oncology , or women's health navigation… 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
- Astellas Pharma (Wheat Ridge, CO)
- …in payer coverage, healthcare payment models, and utilization management criteria (ie Prior Authorization , Step Edits, other forms of precertification), this ... area relevant to the position, such as ophthalmology/retina, urology or oncology , demonstrating a strong understanding of the specific needs and challenges… more
- Providence (Beaverton, OR)
- …of Outpatient Care) + Utilization Management Experience (EX. Concurrent Review, Prior Authorization , Medical Audits, Appeals or Delegation) + Experience ... Coordinator RN, Medicare / Medicaid who will:** + Provide care coordination, case management and care management services to Providence Health Plans(PHP) members +… 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
- Trinity Health (Albany, NY)
- …Submits authorization for initial and subsequent high-cost infusion and oncology services based on complex treatment plans. Coordinates with the patient, ... pre- authorization process. Validates payable diagnosis codes/medical necessity and prior therapy requirements according to FDA and NCCN guidelines. Assists… more
- Option Care Health (Seattle, WA)
- …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