- CVS Health (Tallahassee, FL)
- …Suite applications (Teams, Outlook, Word, Excel, etc.) **Preferred Qualifications** + Previous prior authorization experience + Prefer RN FL Compact license + ... Prior experience working for a health plan or MCO **Education** + Diploma RN or Associates degree in Nursing required + BSN preferred **Anticipated Weekly Hours** 40… more
- University of Miami (Medley, FL)
- …parties of the appointment time, referral criteria, insurance verification, and prior authorization requirements. + Performs all above-mentioned tasks by ... and Patient Access teams to assure pre-registration in the appropriate facility prior to the appointment. Ensure all demographic insurance information is accurate,… more
- University of Miami (Medley, FL)
- …parties of the appointment time, referral criteria, insurance verification, and prior authorization requirements. + Performs all above-mentioned tasks by ... and Patient Access teams to assure pre-registration in the appropriate facility prior to the appointment. Ensure all demographic insurance information is accurate,… more
- Walmart (Orlando, FL)
- …adherence by addressing barriers and coordinating with prescribers, pharmacists, and prior authorization teams. + Monitor patient health status, assess ... treatment response, and provide evidence-based recommendations to care teams. + Ensure compliance with REMS programs, pharmacy policies, and accreditation requirements. + Maintain up-to-date knowledge on oncology medications, administration techniques, and… more
- AdventHealth (Orlando, FL)
- …network of Infusion Centers throughout the area + Excellent staff support including Prior Authorization and Patient Access Specialists + Strong and extensive ... referral network of employed and affiliated PCP's + Large employed orthopedic group + Incredible weather year-round and an abundance of outdoor recreation + Growing, culturally diverse population + No state income tax and a low cost of living + Excellent… more
- Actalent (Miami, FL)
- …Process and verify prescription orders with accuracy and efficiency + Support prior authorization workflows and medication reviews + Communicate with providers, ... patients, and pharmacies to resolve medication-related issues + Maintain compliance with state and federal regulations + Document activities in electronic systems with precision and confidentiality What You Bring + Active Pharmacy Technician license (required)… more
- Humana (Tallahassee, FL)
- …ICD-10 codes. + Member service + Experience with Utilization Review and/or Prior Authorization , preferably within a managed care organization. **Additional ... Information** **Language Proficiency Testing** Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take… more
- Sumitomo Pharma (Tallahassee, FL)
- …services for SMPA's product portfolio, including hub services (benefits investigation, prior authorization , and appeals support), field reimbursement managers, ... Patient Assistance Program (PAP) and copay assistance programs + Drive **data-driven decision-making** , leveraging patient insights and real-world evidence to refine program effectiveness, + **Vendor Oversight** + Oversee **third-party service providers** ,… more
- Cardinal Health (Tallahassee, FL)
- …care and timely access to necessary services + Assist in obtaining insurance, prior authorization , and appeal requirements and outcomes + Help patients ... understand their insurance plan coverage, including out-of-pocket costs, and provide guidance on the appeals process if needed + Resolve patient's questions and any representative for the patient's concerns regarding status of their request for assistance +… more
- CVS Health (Tallahassee, FL)
- …responsible for predetermination reviews and reviews of claim determinations. + This includes Prior Authorization / Pre Certification / Concurrent Reviews / Peer ... to Peer Calls / First Level Appeals / Special Projects and Committee participation when needed. + The Medical Director will provide clinical, coding, and reimbursement expertise as well as directing case management when necessary. + In this role you will… more