- Cardinal Health (Columbus, OH)
- …research and problem/dispute resolution. **_Job Summary_** The Senior Coordinator, Prior Authorization is responsible for obtaining, documenting, and ... supply categories (eg, ostomy, urological, wound care). This role submits prior authorization requests through payer portals or via fax, and conducts phone-based… more
- Humana (Columbus, OH)
- …of our caring community and help us put health first** Humana is seeking a Prior Authorization RN to join the Wisconsin Medicaid Market (iCare) team. This ... position reviews the clinical appropriateness of prior authorization (PA) requests and ensures that all benefits authorized meet medical necessity and other… more
- Elevance Health (Seven Hills, OH)
- …**Build the Possibilities. Make an Extraordinary Impact.** **Title** : Clinical Pharmacist ( Prior Authorization ) **Location(s):** + Indianapolis, IN + Mason, OH ... + Cincinnati, OH + Louisville, KY **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports… more
- UPMC (Steubenville, OH)
- …mission to provide exceptional care at Hillman Cancer Center! Responsibilities: + Prior authorization responsibilities: + 1. Reviews and interprets medical ... system and insurance payor or contracted provider web sites to perform prior authorization , edit, and denial services. + 4. Utilize authorization resources… more
- Elevance Health (Cincinnati, OH)
- …an impact:** + Oversees pharmacist and pharmacy intern associates developing and configuring prior authorization decision trees in the PA workflow tool. + ... Oversees associate performance and quality assurance of prior authorization decision trees within the PA workflow tool. + Provides clinical consulting services… more
- Highmark Health (Columbus, OH)
- …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 (Columbus, OH)
- …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
- TEKsystems (Columbus, OH)
- …verification, pharmacy benefit investigation, or related healthcare services (medical billing, prior authorization support). * Preferred: Familiarity with PBM ... support may be requested during peak periods. Skills insurance verification, prior authorization , medical insurance, Customer service, Multi tasking, Call… more
- Cardinal Health (Columbus, OH)
- …is to provide a detailed outline of clearance criteria as well as prior authorization and advocacy identification for procedures and medications scheduled to ... for benefit investigation as well as clinical clearance for prior authorization and medical necessity + Extensive patient education/counseling to determine… more
- Cardinal Health (Columbus, OH)
- …to secure coverage and reimbursement rate for advanced therapy / CGT products. + ** Prior Authorizations:** Manage the prior authorization process for CGT ... either at a health system or payor) highly preferred + Experience with prior authorization approvals and medical/pharmacy benefit billing & coding, both highly… more