- Centene Corporation (New York, NY)
- …to member care, provider interactions, and facilitates operations within utilization management . + Manages prior authorization , concurrent review, and ... 8:30 am - 5:00 pm with holiday rotation.** **Position Purpose:** Manages Prior Authorization , Concurrent Review, and/or Retrospective Review Clinical Review team… more
- 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 ... :** **JOB SUMMARY** This job captures all inbound phone inquires for utilization management review from providers and pharmacies. The incumbent assesses… more
- Evolent (Albany, NY)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... processing prior authorization requests in accordance with departmental...client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager,… more
- Guthrie (Cortland, NY)
- …Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of prior authorization /certification ... for those with less than one year of experience) Summary The LPN Utilization Management (UM) Reviewer, in collaboration with Care Coordination, Guthrie Clinic… more
- Humana (Albany, NY)
- …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
- Highmark Health (Albany, NY)
- …This job reviews requests for medication coverage determination for prior authorization review and appeals. Through the Utilization Review system, the ... RESPONSIBILITIES** + Make coverage determinations by evaluating physician requests for prior authorization or appeals against medical policy through the… more
- Healthfirst (NY)
- …leadership to UM leaders and teams executing department functions including prior authorizations, concurrent reviews, and service requests + Develop strong ... to maintain and improve department performance + Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement + Lead… more
- Humana (Albany, NY)
- …**Preferred Qualifications** + Bachelor of Science in Nursing. + Experience with case management , discharge planning or prior authorization . + Knowledge of ... help us put health first** Humana is seeking a Prior Authorization RN to join the Wisconsin...and subacute activity daily for outcomes related to readmission, utilization , quality of care and provider performance in compliance… more
- University of Rochester (Rochester, NY)
- …Using clinical judgment and available resources, develops and oversees medication management procedures and strategies to ensure safe and compliant receiving, ... activities as defined by NYS Laws and Regulations. The Pharmacy Medication Utilization and Inventory Compliance Manager has direct supervision and management … more
- Catholic Health Services (Melville, NY)
- …and accurate according to payer requirements. The role will work closely with Utilization Management , Patient Accounts, and other key stakeholders in the revenue ... is required and utilize payer-specific requirements to secure authorization . + Submit prior authorization ...problems created as a result of insurance coverage or prior authorizations. + Foresee and communicate to management… more