- CVS Health (Albany, NY)
- …criteria based & clinical review of medical data collected to perform prior authorization as per policy and procedure. The Pharmacist/Clinician will apply clinical ... physicians or members regarding their pending, approved, or denied prior authorizations, internally support the Prior Auth...or denied prior authorizations, internally support the Prior Auth team and member services department, as well… more
- University of Rochester (Rochester, NY)
- …internal equity considerations._ **Responsibilities:** 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
- 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
- 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
- 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
- University of Rochester (Rochester, NY)
- …data and ensures compliance to enterprise standards and referral and prior authorization guidelines. Communicates regularly with patients, families, clinical and ... follow up. Adheres to approved protocols for working referrals and prior authorizations. **ESSENTIAL FUNCTIONS** + Responsible for managing department referrals.… more
- University of Rochester (Rochester, NY)
- …Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 910335 Ortho Prior Authorization Work Shift: Range: UR URCB 205 H Compensation Range: $20.31 - ... internal equity considerations._ **Responsibilities:** Oversees and provides direction to Prior Authorization and Referral Coordinator Associates and Specialists. Trains… more
- Molina Healthcare (Albany, NY)
- …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
- University of Rochester (Rochester, NY)
- …equity considerations._ **Responsibilities:** Oversees and provides direction to Prior Authorization and Referral Coordinator Associates and Specialists. Trains ... procedures and testing, in alignment with department and enterprise standards. Obtains prior authorizations as needed and assists the team with other assistance as… more
- Centene Corporation (New York, NY)
- …must possess NY RN State Licensure **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service and appropriate ... teams, to assess medical necessity of care of member + Escalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of… more
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