- Molina Healthcare (Tampa, FL)
- …include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... comply with CMS guidelines. These staff may also be involved in providing utilization management / prior authorization services as needed. * Supervises the… more
- Molina Healthcare (Tampa, FL)
- …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 (Tallahassee, FL)
- …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
- Evolent (Tallahassee, FL)
- …care software development methodologies and lifecycles + Experience with utilization management and/or prior authorization processes is preferred + ... design and implement intuitive, efficient, and engaging user interfaces for our Utilization Management health care workflow applications. User research and… more
- Actalent (Sunrise, FL)
- …direct utilization and capture data effectively. Responsibilities + Review prior authorization requests for medical necessity and appropriateness, utilizing ... Utilization Management Nurse!Job Description The ...between the Medical Director, physicians, and office staff, resolving prior authorization issues. + Communicate denial determinations… more
- CVS Health (Tallahassee, FL)
- …and appeal request. This position is primarily responsible for Utilization Management , including prior authorization and precertification as well as ... The Medical Director is part of a centralized team that supports the Medical Management staff and may support other health plans as needed. The Medical Director will… more
- AdventHealth (Orlando, FL)
- …in scheduling peer to peer requests with the office and the payer to ensure an authorization decision is made prior to date of service. + Obtains initial and ... **The role you'll contribute:** The Pre-Access Infusion Benefits and Authorization Specialist, under general supervision, maintains performance standards appropriate… more
- Molina Healthcare (Orlando, FL)
- …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
- Veterans Affairs, Veterans Health Administration (Miami, FL)
- …and follows a capabilities model to achieve goals for eligibility, referral and authorization , care coordination, and utilization management to ensure ... the Veteran's experience and outcomes. Defines mental health policies, utilization management process and procedures, financial and...subject to urinalysis to screen for illegal drug use prior to appointment. Applicants who refuse to be tested… more
- Evolent (Tallahassee, FL)
- …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