- CVS Health (Austin, TX)
- …state of residence. + 3+ years of Nursing experience. Preferred Qualifications + Prior authorization utilization management /review experience preferred ... and external constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications + Registered Nurse in… more
- Elevance Health (San Antonio, TX)
- …personalized support throughout the consumer's treatment journey. **Title:** Utilization Management Representative II - Prior Authorization **Location:** ... Possibilities. Make an extraordinary impact.** The Utilization Management Representative II - Prior Authorization... Utilization Management Representative II - Prior Authorization is responsible for managing incoming… more
- Molina Healthcare (TX)
- …standing Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
- Evolent (Austin, TX)
- …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
- Molina Healthcare (Austin, TX)
- …include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... selected for this position must be licensed in both states.** Molina Pharmacy Services/ Management staff work to ensure that Molina members have access to all… more
- Methodist Health System (Dallas, TX)
- …physicians, clinic support staff, case managers, nurses, insurance utilization management staff, and patients to initiate pre- authorization and resolve ... professional responsible for verification of medical coverage, along with notification, prior authorization , and/or pre-determination of healthcare benefits for… more
- Molina Healthcare (TX)
- … of the state health plan's Healthcare Services (clinical operations) teams including Utilization Management ( prior - authorization , inpatient review) and ... Active, unrestricted State Registered Nursing (RN) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care… more
- Molina Healthcare (TX)
- …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
- Evolent (Austin, TX)
- …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
- Molina Healthcare (Austin, TX)
- …United States who has a compact, multi-state license. This team reviews the prior authorization requests for transplants; the ideal candidate will have ... experience either in utilization review or case management for transplants....and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility… more
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