- Centene Corporation (Tallahassee, FL)
- …perspective on workplace flexibility. **Centene is Hiring - Remote Clinical Review Nurse ( Prior Authorization )!** **Ready to take your nursing career beyond the ... for:** + **RN or LPN with a compact license** + **Experience in prior authorization (managed care or clinical setting)** **Make your nursing background count in… 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 ... + Adhere and perform timely prospective reviews for services requiring prior authorization + Follows the authorization process using established criteria… more
- Polaris Pharmacy Services, LLC (Fort Lauderdale, FL)
- Prior Authorization Technician - Remote Job Details Job Location Polaris Pharmacy Services of Ft Lauderdale - Ft. Lauderdale, FL Remote Type Fully Remote ... Position Type Full Time Job Category Pharmaceutical Description PRIOR AUTHORIZATION SPECIALIST (REMOTE) WHO WE ARE Polaris Pharmacy Services is an industry… more
- Centene Corporation (Tallahassee, FL)
- …Tuesday - Saturday 8A-5PM Florida Residency Required **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service ... teams, to assess medical necessity of care of member + Escalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of… 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
- Molina Healthcare (South Florida, FL)
- …benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina ... its members. + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional… more
- CVS Health (Tallahassee, FL)
- …day. **Position Summary** The Tech I is the initial point of contact for Prior Authorization requests from members, providers, and a diverse customer base. The ... Tech I will make the determination if a complex request should be transferred to a pharmacist for assistance. Additionally, the Tech I is responsible for maintaining complete, timely, and accurate documentation of all approvals and denials. In order to be… 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 ... inspire change. If you join our team, they will. Responsibilities The Authorization Supervisor will provide direct support for the team that verifies insurance… more
- Molina Healthcare (Tampa, FL)
- …benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina ... its members. + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional… more
- Centers Plan for Healthy Living (Margate, FL)
- …authorization requests for eligible members. PRIMARY RESPONSIBILITIES: + Assists in the prior authorization of services and ongoing authorization requests ... the care plan of the member + Coordinates with providers regarding authorization activities + Coordinates communication between authorization clinical staff,… more