- Molina Healthcare (Jacksonville, FL)
- …a compact licensure. The ideal candidate will have experience with UM and prior authorization , within both Physical Health and Behavioral Health. Candidates with ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
- Actalent (Delray Beach, FL)
- …calls. Additionally, they will be cross-trained in pharmacy infusion processes, including prior authorization , order filling, and data entry. Responsibilities + ... customer phone calls. + Cross-train in pharmacy infusion processes such as prior authorization , order filling, and data entry. + Assist with pharmacy support… more
- CVS Health (Tallahassee, FL)
- …4 hours a day working with providers to secure additional information for prior authorization review. This candidate will utilize clinical skills to coordinate, ... management) experience within an **outpatient** setting, concurrent review or prior authorization . + 5 years of a variety clinical experience required… more
- Actalent (Sunrise, FL)
- …to direct utilization and capture data effectively. Responsibilities + Review prior authorization requests for medical necessity and appropriateness, utilizing ... a liaison between the Medical Director, physicians, and office staff, resolving prior authorization issues. + Communicate denial determinations to providers when… more
- Actalent (Orlando, FL)
- …intake and tech review. Initially, the role will focus on the intake of medpharm prior authorization , setting up the PA in their systems, and sending it to ... + Experience in pharmacy and managed care + Data entry skills + Prior Authorization experience + Proficiency in computer skills + Ability to work remotely and… more
- Actalent (Sunrise, FL)
- …satisfaction, safety, and appropriate length of stay. Responsibilities + Review prior authorization requests for medical necessity and appropriateness using ... closely with the interdisciplinary team to perform reviews of service authorization requests, ensuring the utilization of appropriate services. The UMN assists… more
- Monte Nido (Miami, FL)
- …all authorizations for designated programs & departments including single case agreements, prior authorization , continued stay, change in level of care, ... of care recommendations, and feedback on what will be needed for authorization of clinically indicated services. 4. Expectation to provide coverage support across… more
- Akumin (Plantation, FL)
- …responsibility. + May be responsible for verifying insurance coverage and obtain prior authorization . Patient Assistance: + May perform preliminary screening of ... patients prior to procedures, which may include medical history. +...May schedule patient appointments and obtain insurance verification and/or authorization . + May prepare medical records for physicians, patients… 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
- AssistRx (Orlando, FL)
- …and details on how to expedite patient access + Document and initiate prior authorization process and claims appeals + Report any reimbursement trends ... and navigating complex reimbursement issues. This position also provides support for Prior Authorizations (PA) for an assigned caseload and helps navigate the… more