• Medical Case Manager

    Apicha Community Health Center (New York, NY)
    …as needed and report outcome to PCP and multidisciplinary care team. + Obtain prior - authorization for pharmacy or medical services that are not covered by ... patient's health insurance plan + Maintain accurate reporting in both electronic and paper record to ensure and meet all documentation and data reporting requirements of the agency. + Identify and recruit Asians and Pacific Islanders who are living with… more
    Apicha Community Health Center (09/30/25)
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  • Supervisor, Customer Service Management

    Cardinal Health (Albany, NY)
    …enrollment and reimbursement activities, benefit investigations for pharmacy benefit coverage, prior authorization assistance, copay enrollment and other hub ... services. **_Responsibilities_** + Collaboratively oversees daily operations for an inbound and outbound patient access support team. + Ability to maintain development/training goals for team members in a 100% remote setting. + Responsible for creating and… more
    Cardinal Health (09/26/25)
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  • Pharmacist, Utilization Management (UM) Remote

    Molina Healthcare (Yonkers, NY)
    …family include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... pharmacy costs management), clinical pharmacy services (such as, therapeutic drug monitoring, drug regimen review, patient education, and medical staff interaction), and oversight (establishing and measuring performance metrics regarding patient outcomes,… more
    Molina Healthcare (09/25/25)
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  • Nurse Coordinator - Therapeutic Foster Care…

    Hillside Family of Agencies (NY)
    …pre-placements to obtain medical/psychiatric history, establish health care needs, and complete prior authorization for medications or medical necessity based on ... recommendation from the individual's medical providers. + Advocate on behalf of youth/individuals to establish appropriate health care. + Consult and coordinate with outside providers or other members of the participant's health care team to follow-up on… more
    Hillside Family of Agencies (09/23/25)
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  • Utilization Review Nurse

    CDPHP (Latham, NY)
    …responsible for the clinical review and documentation for services requiring prior authorization . This includes approval determinations and appropriate ... exceptions, coordinating with Medical Directors on denials. In addition, the UR nurse is responsible for completing inpatient level of care reviews, post-acute care initial and concurrent reviews for acute and subacute rehabilitation, transportation, DME… more
    CDPHP (09/23/25)
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  • Customer Team Leader, Chronic Care - Houston

    Merck (Albany, NY)
    …customers in the Cardiovascular sector. + Solid understanding of Rx Pathways, and prior authorization process. + Track record of leading successful product ... launch teams in competitive markets. + Proficient in leveraging business analytics and technology to generate insights, develop strategies, and execute plans, while coaching sales teams to utilize these tools effectively. **Minimum Requirements - Skills and… more
    Merck (09/22/25)
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  • Financial Assistant - Billing Specialist

    Lakeview Health Services (Geneva, NY)
    …individuals' boundaries and differences. Essential Job Functions: Billing + Assist with prior authorization requests for services + Confirm client insurance ... eligibility, benefits or current account status information from payer websites + Accurately record client information and communicate appropriately to all relevant parties + Maintain all client accounts with the use of automated billing system via codes meant… more
    Lakeview Health Services (09/21/25)
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  • Field Reimbursement Manager

    Adecco US, Inc. (New York, NY)
    …+ **Benefit & Access Education (25%)** - Educate providers on benefit verification, prior authorization , payer trends, and support center services. Document and ... report all interactions as required by the client. + **Reimbursement Support (20%)** - Assist offices with claims, billing and coding, appeals, medical benefit interpretation, and co-pay or patient assistance programs. Coordinate closely with case managers for… more
    Adecco US, Inc. (09/18/25)
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  • Nurse - Cardiology Office - Triage - Albany, NY-…

    Trinity Health (Albany, NY)
    …cardiac symptoms. Patient education via phone or nurse visits. Prescription refills, prior authorization for medicine. **Position Highlights:** + **Quality of ... Life:** Where career opportunities and quality of life converge + **Advancement:** Strong orientation program, generous tuition allowance and career development + **Work/Life:** Monday - Friday Office Hours **What you will do:** The **Registered Professional… more
    Trinity Health (09/17/25)
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  • Intake Manager (FT/Mon-Fri Days)

    Caz Recovery (Buffalo, NY)
    …and coordinates all referrals to include notification of insurance providers for prior authorization and services covered. + Creates, revises, and implements ... the schedule of the intake department. Requirements + Master's or Bachelor's Degree in Social Work or related field. + Three years' paid full time intake or similar clinical experience, including management experience in intake substance use disorder, dual… more
    Caz Recovery (09/16/25)
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