- Molina Healthcare (Rochester, NY)
- …financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. + Processes ... requests within required timelines. + Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner. + Requests additional information from members or providers in consistent and efficient manner. + Makes appropriate… more
- CDPHP (Albany, 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
- 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
- Northwell Health (New York, NY)
- …to help facilitate the filling of prescriptions, handle/resolve rejections, and obtain prior authorization which will expedite prescriptions into the workflow. + ... Complies with Food and Drug Administration (FDA) mandates and self-imposed manufacturer restrictions on particular drugs, as applicable including Risk Evaluation and Mitigation Strategy (REMS) programs and manufacturer limited distribution drug requirements. +… more
- Centene Corporation (New York, NY)
- …services to ensure level of care and services are medically appropriate + Performs prior authorization reviews related to mental health and substance abuse to ... determine medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall health of member, treatment needs, and discharge planning + Analyzes BH member data to… more
- WMCHealth (Valhalla, NY)
- …ensuring pharmacy services are integrated into patient care workflows + Coordinate prior authorization and financial assistance efforts, working with specialty ... pharmacy technicians to ensure timely access to therapies + Ensure adherence to all regulatory requirements, including 340B program compliance, specialty pharmacy accreditation, and medication safety protocols + Participate in the monitoring and reporting of… more
- Cognizant (Albany, NY)
- …provider, rendering provider, place of service, admission date, referring physician, prior authorization /referral number, procedure code (CPT) and the number ... of units performed, modifiers, and diagnosis code. + Ensure productivity and quality standards are adhered. + Highlights any process improvement ideas. + Update the daily workflow forecast process with any challenges. Requirements: + 2-3 years of experience… more
- Albany Medical Center (Albany, NY)
- …booking process. + Compile booking sheets, all surgical consents, pre-op orders, prior authorization and pre-admission forms. + Preparing patient disability and ... out of work / school paperwork. + Responsible for updating the system with registration, scheduling and insurance information. + Responsible for discussing financial obligation and explaining regulatory forms and answer any questions with patient. + Works in… more
- Cardinal Health (Albany, NY)
- …cycle management specialists simplify and optimize the practice's revenue cycle, from prior authorization through billing and collections._ The **Revenue Cycle ... Management (RCM) Integrations Manager** plays a critical role in ensuring the smooth onboarding and operational integration of new oncology clinical practices into the MSO's centralized revenue cycle framework. This role is responsible for managing all phases… more
- Evolent (Albany, NY)
- …Managers to ensure successful adoption and engagement of Evolent's solutions (ie, prior authorization , clinical pathways) to ensure timely patient access to ... care and drive high provider satisfaction, measured by CSAT and NPS scores + Support the development and execution of innovative engagement opportunities such as regional clinical symposiums and local provider experience advisory panels + Own market level… more