- 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
- Molina Healthcare (NY)
- …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
- Mohawk Valley Health System (Utica, NY)
- …Management - SNH is responsible for the oversight of the case management staff's authorization /coordination/ utilization and provision of member services. ... and training to assist with the day to day operation of the Case Management department. + Assists with identifying over- utilization of services and reports… more
- Guthrie (Corning, NY)
- …and other members of the healthcare team to provide appropriate medical management and resource utilization utilizing established/approved criteria. b) Educates ... Has an understanding of the regulatory requirements relative to the case management process. Certified to complete Patient Review Instruments (PRIs). Has a working… more
- Arnot Health (Elmira, NY)
- …Assists in tracking/trending by payer for denial reason items such as prior authorization , untimely filing, coordination of benefits, services type issues, ... to $10,000 Sign on Bonus for qualified Case Managers! MAIN FUNCTION: The Case Management (denial/ prior auth) will review and appeal as appropriate for concurrent… more
- Molina Healthcare (NY)
- …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 (Montrose, NY)
- …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
- Sanofi Group (Albany, NY)
- …for Health Care Providers (HCPs) and Patients. Payer medical and pharmacy Utilization Management (UM) criteria create process delays for patients like ... required Benefits Investigations (BI), Prior Authorization (PA), Denial Appeals, detailed Clinical...local and national payer landscape, including Specialty Pharmacy and Utilization Management criteria for TZIELD + Reactively… more
- Stony Brook University (Stony Brook, NY)
- …with the transferring hospital, Patient Access and physicians and payers for authorization prior to transfer from other hospitals. + Consistent documentation ... the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity...and communication with the team. Charting includes data for authorization and data management . + Reviews cases… more
- Evolent (Albany, NY)
- …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
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