- Humana (Phoenix, AZ)
- …part of our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting medical ... necessity and comprehensive medication reviews for prescriptions requiring prior authorization . This role involves evaluating complex clinical scenarios and… more
- CVS Health (Phoenix, AZ)
- …of relevant experience in Nursing. + At least 1 year of Utilization Management experience in concurrent review or prior authorization . + Strong ... high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join...+ Experience in a high-volume clinical call center or prior remote work environment. **Education** + Associate's degree in… more
- Molina Healthcare (Tucson, AZ)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
- Evolent (Phoenix, AZ)
- …Analyst, Scope Management plays a crucial role in supporting the comprehensive management of prior authorization and financial scope within Evolent ... and maintain the definitive source of truth for specialty Utilization Management (UM) agreements. This important work...impactful manner. + Perform other duties related to the management of prior authorization and… more
- Molina Healthcare (Mesa, AZ)
- …include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... **JOB DESCRIPTION** **Job Summary** Molina Pharmacy Services/ Management staff work to ensure that Molina members...+ Performs initial receipt and review of non-formulary or prior authorization requests against plan approved criteria.… more
- Evolent (Phoenix, AZ)
- …teams and stakeholders. + Familiarity with healthcare claims, reimbursement methodologies, and cost/ utilization KPIs, including prior authorization data and ... insights to internal and external stakeholders. + Experience with value-based care, utilization management , or regulatory reporting (eg, HEDIS, NCQA, Milliman).… more
- Highmark Health (Phoenix, AZ)
- …Committee review. + Assist in the development and implementation of utilization management programs including but not limited to: prior authorization , ... account, and member educational initiatives that promote the Organization's Formularies, utilization management programs, and disease management initiatives.… more
- Molina Healthcare (Scottsdale, AZ)
- …Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
- CVS Health (Phoenix, AZ)
- …for clinical and legal review. + Provide day-to-day support and guidance for ABA prior authorization clinical team and the health plan medical directors. + ... Attend and participate in clinical meetings with care management and utilization management . Provide subject matter expertise on all ABA-related questions… more
- Adelante (Surprise, AZ)
- …will work with patients to close gaps in care, provide insurance, referral, and prior authorization support, and may also conduct patient outreach to follow up ... planning, and maintaining health records by following the document management process. The Administrative Medical Assistant also will be...Advocate + Close gaps in care by assisting with prior authorization support and referrals + Perform… more