- Molina Healthcare (Fort Worth, TX)
- …include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... through Friday from 1230pm to 9pm MST. Molina Pharmacy Services/ Management staff work to ensure that Molina members have...+ Performs initial receipt and review of non-formulary or prior authorization requests against plan approved criteria.… more
- Humana (Austin, TX)
- …role, you will be a key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with a focus ... members. The Director, Physician leadership will lead Medical Directors performing utilization management for Medicare inpatient and behavioral medicine case… more
- CenterWell (Austin, TX)
- …Clinical Drug Policy Management team which ensures synchronization of formulary utilization management policies across multiple systems. Humana is seeking a ... help facilitate clinical medication review decision making. + Responsible for operationalizing prior authorization criteria into Humana systems in alignment with… more
- Centene Corporation (Austin, TX)
- …with other departments, such as medical case/care management . Perform utilization management functions, including authorization determinations and care ... including care shaping and authorization determinations. + Responsible for utilization management activities with providers and/or member calls, depending on… 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 (Fort Worth, TX)
- …room. + Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... requested treatments and/or procedures. + Conducts reviews to determine prior authorization / financial responsibility for Molina...teams to promote Molina care model. + Adheres to utilization management (UM) policies and procedures. +… more
- Molina Healthcare (Fort Worth, TX)
- …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 (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,...CMS standards. + Provides coordination and processing of pharmacy prior authorization requests and/or appeals. + Explains… more
- Cardinal Health (Austin, TX)
- …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 (Austin, TX)
- …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
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