- Molina Healthcare (Tacoma, WA)
- …seeking a candidate with a WA state LPN licensure. Candidates with previous prior authorization and MCO experience are highly preferred. Further details to be ... Oversees an integrated Care Access and Monitoring team responsible for prior authorizations and/or other utilization management activities aimed at providing Molina… more
- SUNY Upstate Medical University (Syracuse, NY)
- …medical necessity of medication use based on established criteria. Obtain prior authorization from intermediaries and payers, including managed care companies, ... activities that maximize revenue capture for high-cost medications. Conduct prospective prior authorization services to expedite clinic workflow and enhance patient… more
- Molina Healthcare (Spokane, WA)
- …and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare ... members. + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information… more
- Actalent (Eugene, OR)
- Job Title: Clinical Review Nurse - Prior Authorization Job Description This role involves analyzing all prior authorization requests to determine the medical ... the medical necessity of care for members. + Escalate prior authorization requests to Medical Directors as necessary to...or Registered Nurse (RN) certification. + Clinical review and prior authorization experience. + 2-4 years of prior… more
- Saratoga Hospital (Saratoga Springs, NY)
- Referral & Prior Authorization Specialist Salary Range: $18.22-$28.27/hr, based on experience and qualifications About Saratoga Hospital At Saratoga Hospital, we've ... with exceptional people. About the Role We're looking for a dedicated Referral & Prior Authorization Specialist to join our team and help us continue delivering the… more
- Centene Corporation (Austin, TX)
- …**Hours: 10:00 am - 7:00 pm CST** **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service and appropriate level ... teams, to assess medical necessity of care of member + Escalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of… more
- Mille Lacs Health System (Onamia, MN)
- …the direction of the Health Information Supervisor/Director of Revenue Cycle. The Prior Authorization Coordinator (PAC) is responsible for ensuring that payers are ... end of the bullet point. + Receive requests for prior authorizations and ensure that they are properly and...+ Collaborate with other departments to assist in obtaining prior authorizations/appeals. + Work with Business Office staff to… more
- University of Washington (Seattle, WA)
- …PHARMACY DEPARTMENT** has an outstanding opportunity for a **PHARMACY TECHNICIAN 2 - PRIOR AUTHORIZATION CENTER** . **WORK SCHEDULE** * Part-Time / 20 hours per week ... * Perform specialized, technical pharmacy tasks related to the management of prior authorization for patients served by the UWMC ambulatory clinics * Act… more
- University of Rochester (Rochester, NY)
- …considerations._ **Responsibilities:** GENERAL PURPOSE Serves as the patient referral and prior authorization specialist, with oversight of data and compliance to ... enterprise standards and referral and prior authorization guidelines. Communicates regularly with patients, families, clinical and non-clinical staff, identifying… more
- US Tech Solutions (May, OK)
- …role that conducts clinical reviews of medical data collected to perform prior authorization for commercial and specialty medications. + The clinical pharmacist will ... calls from physician or members regarding their pending, approved, or denied prior authorizations. **Responsibilities:** + Evaluate and review all prior … more