- Evolent (Sacramento, CA)
- …learning models and algorithms to primarily improve the performance of our prior authorization platforms + Construct advanced SQL queries, perform preprocessing, ... systems into production environments + Healthcare experience, particularly using administrative and prior authorization data, with a passion for solving problems… more
- The County of Los Angeles (Los Angeles, CA)
- …response team. + Assists Psychiatrists in completing and checking for accuracy on Treatment Authorization Request (TAR) and Prior Authorization (PA) forms. + ... needs of the service are met and is subject to closure without prior notice. TYPE OF RECRUITMENT Open Competitive Job Opportunity DEFINITION Provides specialized… more
- UCLA Health (Los Angeles, CA)
- …of prescription management, fulfillment and patient outreach which also includes prior authorization , financial assistance and prescription coordination. At UCLA ... license + PTCB Certification - Preferred + Experience in submitting prior authorization and financial assistance + 2-3 years of Pharmacy Technician experience… more
- Humana (Sacramento, CA)
- …health outcomes of our members. + _Outcomes_ : Characterize the impactable drivers of prior authorization and look at appeals rate with denials and overturns. ... following domains: + _Access_ _:_ Ensure Humana members have fair and consistent authorization review and ability to appeal and have justification for the clinical… more
- Actalent (Santa Cruz, CA)
- …supporting care coordination. + Schedule appointments with multiple departments and handle prior authorization with medication. Essential Skills + Possession of ... appointment schedule. Responsibilities + Administer and coordinate referrals and service authorization processes. + Perform rooming duties and other clinic front… more
- United Therapeutics (CA)
- …coverage/utilization management criteria, insurance forms & procedures, benefits investigation, prior authorization , appeal, and/or claims resolution + Educate ... and consultative approach providing education to offices related to insurance authorization and/or reimbursement of products for appropriate patients. + Manage… more
- Evolent (Sacramento, CA)
- …with healthcare claims, reimbursement methodologies, and cost/utilization KPIs, including prior authorization data and key performance indicators (eg, ... Doing:** + **Data Analytics & Insights** : Analyze healthcare claims and authorization data to identify cost drivers, utilization trends, and population health… more
- Cardinal Health (Fresno, CA)
- …claim has been captured. + Effectively works with insurance companies, obtaining prior authorization for physician dispensing medication claims that are ... rejected. Follows up on submitted authorization requests as needed. + Effectively completes other assignments as assigned by management. **_Qualifications_** + High… more
- Sanofi Group (Los Angeles, CA)
- …therapy + Liaise during the Benefit Verifications process and follow-up for timely prior authorization and appeal completion + Manage general inquiries via phone ... experience (ie medical benefit coverage) + 5-10 years of prior case management experience or healthcare experience + 5-10...management experience or healthcare experience + 5-10 years of prior field reimbursement manager experience + 3 years or… more
- Sharp HealthCare (San Diego, CA)
- …profile/EHR and other records as appropriate.Complete UM reviews for medication prior authorization referrals in accordance with appropriate criteria (eg ... problems, assessment of medication adherence barriers, medical necessity, drug prior authorizations, and other related activities.Develops patient centered pharmaceutical… more