- Evolent (Lansing, MI)
- …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 (Lansing, MI)
- …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 (Detroit, MI)
- …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
- Molina Healthcare (Detroit, MI)
- …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,...CMS standards. + Provides coordination and processing of pharmacy prior authorization requests and/or appeals. + Explains… more
- Cardinal Health (Lansing, MI)
- …is to provide a detailed outline of clearance criteria as well as prior authorization and advocacy identification for procedures and medications scheduled to ... to representatives for benefit investigation as well as clinical clearance for prior authorization and medical necessity + Extensive patient education/counseling… more
- Molina Healthcare (Detroit, MI)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / ... financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. + Processes… more
- Molina Healthcare (Detroit, MI)
- …Services, pharmacies, and health plan providers in resolving member prescription claim, prior authorization , or pharmacy services access issues. + Articulates ... and state laws. Jobs in this family include those involved in formulary management (such as, reviewing drug/provider utilization patterns and pharmacy costs … more
- Molina Healthcare (Detroit, MI)
- …physician leadership and expertise in the performance of prior authorization , inpatient concurrent review, discharge planning, case management and ... years experience as a Molina Medical Director + Demonstrated experience in Utilization /Quality Program management + Previous leadership experience + Peer review,… more
- Prime Therapeutics (Lansing, MI)
- …and timely fashion. + Demonstrates the value of pharmacy solutions (unit cost, utilization management & patient care enhancement). + Identifies opportunities for ... functions, DUR committees and responsibilities. + Supports elevated customer service and prior authorization inquiries specific to assigned accounts. + Manages… more
- CRST (MI)
- …anniversary. We offer services including truckload capacity, flatbed, transportation management , dedicated services, white-glove handling, team expedited and final ... Wages (Pay Bi-Weekly) *A final amount is dependent on factors including prior relevant experience, knowledge, and location. Typically, selected candidates are hired… more
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