- Evolent (Albany, NY)
- …and informatics professionals who work with national health plans to ensure that prior authorization and financial coding stay accurate, compliant, and aligned ... Management plays a crucial role in supporting the comprehensive management of prior authorization and financial scope within Evolent Specialty Services.… more
- Evolent (Albany, NY)
- …team, ensuring the effective and efficient management of operations related to prior authorization services for healthcare companies. This role is essential ... + Implement and manage processes that enhance efficiency and effectiveness in handling prior authorization requests. + Analyze call metrics and other performance… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …authorization requests for eligible members. PRIMARY RESPONSIBILITIES: + Assists in the prior authorization of services and ongoing authorization requests ... the care plan of the member + Coordinates with providers regarding authorization activities + Coordinates communication between authorization clinical staff,… more
- Molina Healthcare (Rochester, NY)
- …family include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... **KNOWLEDGE/SKILLS/ABILITIES** + Performs initial receipt and review of non-formulary or prior authorization requests against plan approved criteria. Requests… more
- Molina Healthcare (Albany, NY)
- …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
- US Tech Solutions (New York, NY)
- …based role that conducts clinical reviews of medical data collected to perform prior authorization for specialty medications. The clinical pharmacist will apply ... Handles inbound phone calls and escalations from physicians or patients regarding Prior Authorization (50%) 4. Establishes and maintains communication, health… more
- Bassett Healthcare (Cooperstown, NY)
- …back learning to the team, and is a go to person for coworkers. Obtains prior approval or prior authorization as needed. Communicates referral appointment ... signatures and form processing to meet Medicare regulations. Obtains prior approval or prior authorization as needed. Communicates referral appointment and… more
- Elevance Health (Latham, NY)
- …Management Representative I** will be responsible for coordinating cases for precertification and prior authorization review. **How you will make an impact:** + ... eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization , and post service requests. + Refers cases… more
- Albany Medical Center (Albany, NY)
- …(ICU or floor admitting MD/Pharmacy/Nurse Manager/Clinical Nurse Specialist/Consulting MD), prior authorization , protocols for inpatient oral food ... (ICU or floor admitting MD/Pharmacy/Nurse Manager/Clinical Nurse Specialist/Consulting MD), prior authorization , protocols for inpatient oral food… more
- Bassett Healthcare (Hamilton, NY)
- …of network insurance deductibles and "co-insurance." Acquires medical necessity documentation Obtains prior approval or prior authorization as required by ... appointment instructions to the patient Communicates with clinicians to bring referral/insurance/ prior authorization updates Acts as a liaison with external… more