- Lake Region Healthcare (Fergus Falls, MN)
- …will facilitate the gathering of information to verify medical necessity to meet prior authorization and insurance referral requirements, as well as gather ... to: + Receive and review requests from provider and determine if a prior authorization is required according to the payer's criteria. + Gather, collect and… more
- Adecco US, Inc. (Minneapolis, MN)
- …authorizations submitted by providers within the designated turnaround times specified in the Prior Authorization List for all lines of business, including RMHP ... RMHP CHP+, RMHP IFP, and NHP RAE Medicaid + When processing authorization requests, the Clinical Coordinator applies approved medical necessity criteria and… more
- Highmark Health (St. Paul, MN)
- …claims history, clearly defines the medical necessity of non-formulary and prior authorization medication exception requests. Interacts with pharmacy network ... Prioritize requests for drug authorizations or denials. + Review of prior authorization criteria for drug products. + Recommend staffing adjustments necessary to… more
- CenterWell (St. Paul, MN)
- …Specialty Care to lead strategy and execution for our referral management, payer prior authorization , and specialist network solutions. This role is critical to ... Define and track KPIs related to referral throughput, network utilization, and prior authorization efficiency; use data to drive continuous improvement. +… more
- Blue KC (Workman, MN)
- …available resources to promote optimal, cost-effective outcomes. Transplant only: Provides prior authorization for, coordinates, and individually manages all ... work appropriately. Additional duties for Transplant only: + Provides prior authorization of the transplant and manages individual member cases. Reviews… more
- Mayo Clinic (Rochester, MN)
- …ahead of a provider visits, researching prescription discrepancies, and/or facilitating prior authorization denials. The LPN collaborates daily with providers, ... ahead of a provider visits, researching prescription discrepancies, and/or facilitating prior authorization denials. The LPN collaborates daily with providers,… more
- Mayo Clinic (Rochester, MN)
- …ahead of a provider visits, researching prescription discrepancies, and/or facilitating prior authorization denials. The LPN collaborates daily with providers, ... and written). Experience working in a team environment. Computer skills required, prior experience with electronic medical record systems preferred. Ability to work… more
- Merck (St. Paul, MN)
- …and/or education to HCP accounts on patient access, including benefit verification, prior authorization process, appeals process, and patient support programs in ... B, Medicaid, commercial) and related access processes, including benefit verification, prior authorization , and appeal processes * Expertise in pharmaceutical… more
- Highmark Health (St. Paul, MN)
- …**JOB SUMMARY** This job reviews requests for medication coverage determination for prior authorization review and appeals. Through the Utilization Review ... RESPONSIBILITIES** + Make coverage determinations by evaluating physician requests for prior authorization or appeals against medical policy through the… more
- Mayo Clinic (Rochester, MN)
- …Mayo Clinic Specialty Pharmacy, Infusion Therapy Center, and insurance prior authorization teams. **Qualifications** **Required Qualifications** + ... is preferred. + Skills and Experience in Practice and Practice Development: Prior involvement in **practice initiation** , **development** , **community service** ,… more