- Molina Healthcare (South Florida, FL)
- …and its members. + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
- Sanofi Group (St. Petersburg, FL)
- …billing and coding, financial assistance offerings, patient support, access, payer medical policy, prior authorization , specialty pharmacy operations, ... with complex medical payer policy requirements and coordination of multiple prior authorization needs + Infusion therapy experience + Home care coordination… more
- University of Miami (Miami, FL)
- …Case Manager RN - Full Time The University of Miami is currently seeking a Prior Authorization Nurse Case Manager. The incumbent purose is to conduct initial ... chart reviews for medical necessity and identify the need for authorization...Adhere and perform timely prospective reviews for services requiring prior authorization + Follows the authorization… more
- Polaris Pharmacy Services, LLC (Fort Lauderdale, FL)
- Prior Authorization Technician - Remote Job...of the business. BENEFITS for full time employees + Medical , Dental, and Vision insurance + 401 (k) (available ... Type Fully Remote Position Type Full Time Job Category Pharmaceutical Description PRIOR AUTHORIZATION SPECIALIST (REMOTE) WHO WE ARE Polaris Pharmacy Services… more
- 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 ... initial, concurrent and retrospective chart reviews for clinical utilization and authorization . The Utilization Review Case Manager coordinates with the healthcare… more
- Surgery Care Affiliates (Belleair Beach, FL)
- …of team members. + Experience with insurance regulations, clinical review, and prior authorization . + Excellent ability to conduct quality assurance audits ... package to support your health, well-being, and financial future. Our offerings include medical , dental, and vision coverage, 401k plan with company match, paid time… more
- Molina Healthcare (Tampa, FL)
- …and its members. + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …and outpatient service requests. + Reviews cases referred by the prior - authorization non-clinical medical management coordinator and pre-certification ... policies or MCG(R) screening criteria. Responsibilities: + Manages appropriate cases that require medical necessity review such as home care, elective inpatient… more
- Actalent (Sunrise, FL)
- …staff to direct utilization and capture data effectively. Responsibilities + Review prior authorization requests for medical necessity and appropriateness, ... between the Medical Director, physicians, and office staff, resolving prior authorization issues. + Communicate denial determinations to providers when… more
- Molina Healthcare (Jacksonville, FL)
- …and its members. + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests ... a compact licensure. The ideal candidate will have experience with UM and prior authorization , within both Physical Health and Behavioral Health. Candidates with… more