- Bon Secours Mercy Health (Cincinnati, OH)
- …Obtain necessary insurance pre- authorization and pre-certifications. Responsible for prior authorization and registration functions. + Ensures accurate ... patient identification by consistently verifying two patient identifiers in accordance with hospital policy and patient safety standards. This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions… more
- Select Medical (Columbus, OH)
- …financially viable. + Communicate relevant data to clinical liaisons, case managers, prior authorization team, and physicians to help prepare for admission. ... signed consent to treat forms and file. **Qualifications** **Qualifications** + Prior experience in a hospital, physician practice or insurance environment. +… more
- Regeneron Pharmaceuticals (Columbus, OH)
- …and Patients. Payer Formularies and restrictive Utilization Management Criteria including Prior Authorization Processes, Step Edits, Appeals, detailed Clinical ... such checks is for Regeneron to verify certain information regarding a candidate prior to the commencement of employment such as identity, right to work, educational… more
- Actalent (Toledo, OH)
- …team. + Strong adaptability and multitasking. Skills Pharmacy, Pharmd, Data entry, Prior authorization , Customer service, Pharmacy benefits management Top Skills ... Details Pharmacy,Pharmd,Data entry Additional Skills & Qualifications - High School diploma or equivalent is required - Minimum of 2 years' experience in the pharmacy field - Active Ohio Pharmacy Technician License - Basic Life Support (BLS) (Can be renewed or… more
- ProMedica Health System (Toledo, OH)
- …history collection, inpatient reviews, medication stewardship, patient education, prior authorization facilitation, referral procurement, and discharge ... medication reconciliation preparation via system process. + Assists and supports the development, implementation, and management of clinical pharmacy services through idea sharing, process development, and feedback review. + Provides ongoing clinical drug… more
- Humana (Columbus, OH)
- …conducting medical necessity and comprehensive medication reviews for prescriptions requiring prior authorization . This role involves evaluating complex clinical ... scenarios and applying evidence-based criteria to ensure appropriate medication use. The pharmacist addresses moderately complex to complex issues that require critical thinking and in-depth analysis of variable factors. **_Earn a $5,000 hiring bonus!_**… more
- Elevance Health (Mason, OH)
- …for the interpretation and data entry of moderately complex prescriptions, prior authorization processing, and troubleshooting adjudication issues. **How you ... will make an impact:** + Verifies member information and inputs data for the pharmacists. + Educates members about prescriptions and medication resources or assistance programs. + Educates members on medication adherence-related topics to align closely with… more
- Prime Therapeutics (Columbus, OH)
- …functions, DUR committees and responsibilities. + Supports elevated customer service and prior authorization inquiries specific to assigned accounts. + Manages ... financial aspects of account(s). + Ensures revenue goals are met, cost of care and administrative expenses managed, and EBIDTA targets achieved for the assigned account(s). + Ensures contract performance through risk management activities including such items… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …Develop and chair a utilization management review committee and partner with the prior authorization team. + Review high-cost and high-volume referral tests for ... clinical appropriateness and develop test algorithms, where applicable. + Prepare business case proposals on appropriate buy vs sell initiatives of tests that can be internalized. Determine optimal instrumentation necessary to insource referral tests. + Track… more
- Humana (Columbus, OH)
- …+ Deep understanding of pharmacy operations, PBM models, benefits coordination, prior authorization workflows, and specialty care dynamics + Exceptional ... project management skills; able to build clear technical implementation plans, manage cross-functional teams, and drive accountability + Ability to thrive in a fast-paced environment; balances strategic thinking with tactical execution and can simplify… more