- CVS Health (Lansing, MI)
- …At least 1 year of Utilization Management experience in concurrent review or prior authorization . + Strong decision-making skills and clinical judgment in ... organization (MCO). + Experience in a high-volume clinical call center or prior remote work environment. **Education** + Associate's degree in nursing (RN) required,… more
- Evolent (Lansing, MI)
- …Managers to ensure successful adoption and engagement of Evolent's solutions (ie, prior authorization , clinical pathways) to ensure timely patient access to ... background check, in-person I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools during interviews is… more
- Henry Ford Health System (Livonia, MI)
- …working in a clinic/office setting. Family Practice experience a plus. Prior authorization experience would be great. Responsibilities Include: Supporting ... . Practical/Vocational Nurse credentialed from the Michigan Board of Nursing obtained prior to hire date or job transfer date required. EDUCATION/EXPERIENCE REQUIRED… more
- CVS Health (Lansing, MI)
- …and fast-paced role, you will be responsible to verify insurance coverage and obtain prior authorization information for both new and existing patients in order ... to process patient prescription orders in a timely manner while demonstrating excellent customer service to patients, healthcare professionals and insurance carriers. This role will require an understanding of insurance carriers and concepts including pharmacy… more
- Corewell Health (Grand Rapids, MI)
- …reconciles multi-department deposit. + Obtains insurance authorizations and/or verifies that prior authorization has been obtained; assists with retroactive ... insurance denials/appeals. + Responsible for complex EMR/EHR scanning and Right Fax faxing and uploading to EPIC. + Assists with training new team members utilizing standard work. + Ability to perform the role of Patient Services Representative, Associate when… more
- CVS Health (Lansing, MI)
- …for pharmacy task functions including intake, benefits verification, order scheduling, prior authorization management, clinical reviews, as well as additional ... off-phone and administrative operations critical to specialty pharmacy services. This leader will ensure all pre-shipment issues are corrected to mitigate financial impact. This position requires strong leadership, analytical skills, and a deep understanding… more
- Molina Healthcare (MI)
- …pharmacies, and health plan providers in resolution of member prescription claim, prior authorization , and pharmacy service access issues. * Articulates pharmacy ... management policies and procedures to pharmacy/health plan providers, Molina staff and others as needed. Required Qualifications * At least 2 years pharmacy technician experience, preferably supporting Medication Therapy Management (MTM), or equivalent… more
- CVS Health (Lansing, MI)
- …Components:** * Utilization management - The medical director will perform concurrent and prior authorization reviews with peer to peer coverage of denials. * ... Appeals - The medical director will perform appeals in their "base plan" and in the round robin based on "same or similar specialty" needs. * Pharmacy coverage - The medical director will perform pharmacy reviews. * The medical director will participate in and… more
- CVS Health (Lansing, MI)
- …responsible for predetermination reviews and review 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
- University of Michigan (Ann Arbor, MI)
- …+ Troubleshoot complex medication-related issues and make suggestions for improvement (insurance/ prior authorization , medication history, etc.) + Identify and ... participates in additional projects as needed. Pharmacy Technician Senior: Pharmacy Technician Senior is expected to be able to perform all of the essential characteristic duties and responsibilities of the Pharmacy Technician Intermediate. They will have… more