- BrightSpring Health Services (New Hyde Park, NY)
- …authorizations. This role requires working knowledge of pharmacy benefits and prior authorization process. Schedule: ( Remote )Monday - Friday8:30am - ... + Initiate, process, and oversee the clinical review of prior authorization requests for medication and supply,...Qualifications + High School Diploma or GED or licensed/registered pharmacy technician or previous experience in Pharmacy … more
- Molina Healthcare (NY)
- …/health plan providers, Molina staff and others as needed. * Performs prior authorization reviews of high-cost medications and deferred authorization ... JOB DESCRIPTION **Job Summary** Provides support and subject matter expertise for pharmacy Medication Therapy Management (MTM) and clinical pharmacy services… more
- Molina Healthcare (Yonkers, NY)
- …those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs ... **JOB DESCRIPTION** **Job Summary** Molina Pharmacy Services/Management staff work to ensure that Molina...responsible for creating, operating, and monitoring Molina Health Plan's pharmacy benefit programs in accordance with all federal and… more
- KPH Healthcare Services, Inc. (Syracuse, NY)
- …+ Responsible for contacting members and prescribers on non-covered items + Facilitate prior authorization process for customers + Provide clinical services in ... **Educational Requirements:** + Minimum: High School Diploma or GED + Preferred: Pharmacy technician or related certification **Experience:** + Past experience in a… more
- Amgen (New York, NY)
- …order to reimbursement, supporting the entire reimbursement journey through payer prior authorization to appeals/denials requirements and forms + Review ... coverage/utilization management criteria, insurance forms & procedures, benefits investigation, prior authorization , appeal, and/or claims resolution + Educate… more
- Adecco US, Inc. (New York, NY)
- …+ **Benefit & Access Education (25%)** - Educate providers on benefit verification, prior authorization , payer trends, and support center services. Document and ... **Job Title:** Field Reimbursement Manager (FRM) - Remote with Territory Travel **Location:** Remote - Must reside in NYC **Travel:** Up to 80% (4 days/week) via… more
- J&J Family of Companies (New City, NY)
- …billing. + Reimbursement or relevant managed care experience (revenue cycle, buy-and-bill, prior authorization , coding, and appeals processes) + Ability to ... + Immunology disease state experience + Advanced degree and/or relevant certifications in prior authorization and/or billing and coding + Strong market access… more
- Cardinal Health (Albany, NY)
- …performing customer service, enrollment and reimbursement activities, benefit investigations for pharmacy benefit coverage, prior authorization assistance, ... streamline patient onboarding, qualification and adherence. Our non-commercial specialty pharmacy is centralized at our custom-designed facility outside of Dallas,… more
- Highmark Health (Buffalo, NY)
- …creates the case (data entry) in Highmark's Utilization Management system for Prior Authorization clinical review. Ensures all accurate information is entered ... require support. **ESSENTIAL RESPONSIBILITIES** + Obtain requests from provider or pharmacy via fax, provider portal or service form inquiry.May obtain requests… more
- Project Renewal, Inc. (New York, NY)
- …monitoring + Review of prescription monitoring program to track prescribing and pharmacy fill history + Insurance authorization and troubleshooting coverage ... low-threshold and trauma-informed care and motivational interviewing techniques + Prior experience conducting individual patient education and counselling sessions.… more
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