- Highmark Health (Buffalo, NY)
- …to fulfill the call, such as verifying benefit coverage, creation of a prior authorization case in Highmark's Utilization Management system for Prior ... **ONLY This job captures all inbound phone inquires for utilization management review from providers and pharmacies....phone requests from providers or pharmacy for all inbound Prior Authorization requests.Use multiple software systems and… more
- Kelly Services (Greece, NY)
- **Kelly(R) is looking for a Pharmacy Prior Authorization Technician to work at a top insurance client in the Greece, NY/ Rochester, NY area. Let us help you grow ... **Hours:** M-F 8am to 5pm **Summary Description:** The Pharmacy Prior Authorization Technician is responsible for the...policies and procedures to prepare and interpret cases for utilization management reviews. As a content expert,… more
- Centene Corporation (New York, NY)
- …**8:30am-5pm, Monday-Friday Eastern Standard hours.** **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of ... interdepartmental teams, to assess medical necessity of care of member + Escalates prior authorization requests to Medical Directors as appropriate to determine… more
- University of Rochester (Rochester, NY)
- …such as Medicaid Enrollment & Outreach, Financial Assistance, Registration and Insurance Management , Utilization Management , Social Work, Patient Accounts, ... Medical Records, Home Care Coordinators, Prior Authorization Teams, Contracting and Finance. +...experience REQUIRED. **KNOWLEDGE, SKILLS & ABILITIES** + Experience in management , operations, and leadership PREFERRED. + Requires a high… more
- Elevance Health (Latham, NY)
- ** Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... integration, and ensures essential face-to-face onboarding and skill development. The ** Utilization Management Representative I** will be responsible for… more
- Centene Corporation (New York, NY)
- …services to ensure level of care and services are medically appropriate + Performs prior authorization reviews related to mental health and substance abuse to ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- CDPHP (Albany, NY)
- …responsible for the clinical review and documentation for services requiring prior authorization . This includes approval determinations and appropriate ... required as a Registered Nurse. + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of coding/claims processing is preferred.… more
- Highland Hospital (Rochester, NY)
- …insurance eligibility and coverage verification using the three patient identifiers, confirming prior authorization is on file for correct level of care, ... benefits, identifies and resolves coordination of benefits discrepancies, and notifies Utilization Management of additional clinical requests **Salary Range:**… more
- Molina Healthcare (Albany, NY)
- …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
- CDPHP (Albany, NY)
- …+ Experience with managed care pharmacy principles including prior authorization reviews, formulary management , and utilization review preferred. ... I is primarily responsible for the operational review of pharmacy medical exception/ prior authorization requests, the communication to members and providers on… more
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