- Prime Therapeutics (Harrisburg, PA)
- …Liaison - Remote **Job Description** Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone ... office staff, medical management staff and/or pharmacists. Researches, resolves and documents prior authorization outcomes in pharmacy system. + Communicates… more
- Cardinal Health (Harrisburg, PA)
- …either at a health system or payor) highly preferred + Experience with prior authorization approvals and medical/ pharmacy benefit billing & coding, ... to secure coverage and reimbursement rate for advanced therapy / CGT products. + ** Prior Authorizations:** Manage the prior authorization process for CGT… more
- Prime Therapeutics (Harrisburg, PA)
- …functions, DUR committees and responsibilities. + Supports elevated customer service and prior authorization inquiries specific to assigned accounts. + Manages ... those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us. **Job Posting Title** Georgia Medicaid Clinical Account Manager - … more
- Highmark Health (Harrisburg, PA)
- …**JOB SUMMARY** This job reviews requests for medication coverage determination for prior authorization review and appeals. Through the Utilization Review ... RESPONSIBILITIES** + Make coverage determinations by evaluating physician requests for prior authorization or appeals against medical policy through the… more
- Cognizant (Harrisburg, PA)
- …Excellent problem-solving and communication skills **These will help you stand out** + Prior experience in healthcare or pharmacy systems (RxClaim) + Familiarity ... testing and provide technical support throughout the project lifecycle **Work model: Remote ** We strive to provide flexibility wherever possible. Based on this… more
- Humana (Harrisburg, PA)
- …Solutions ensuring compliance with programmatic requirements, such as claims processing, prior authorization , formulary management and clinical programming + ... scope and complexity ranging from moderate to substantial. The Pharmacy Director, internally known as a Clinical Pharmacy...on Humana's secure website. Travel: While this is a remote position, occasional travel to Humana's offices for training… more
- Centene Corporation (Harrisburg, PA)
- …recommend plan design changes, and clinical programs to be initiated + Monitor prior authorization requests + Provide clinical support to internal departments ... benefits including a fresh perspective on workplace flexibility. **Location: Position is remote . Prefer candidate to live in PA. Will work EST hours.** **Must… more
- CenterWell (Harrisburg, PA)
- …Specialty Care to lead strategy and execution for our referral management, payer prior authorization , and specialist network solutions. This role is critical to ... Define and track KPIs related to referral throughput, network utilization, and prior authorization efficiency; use data to drive continuous improvement. +… more
- Merck (North Wales, PA)
- …and/or education to HCP accounts on patient access, including benefit verification, prior authorization process, appeals process, and patient support programs in ... B, Medicaid, commercial) and related access processes, including benefit verification, prior authorization , and appeal processes * Expertise in pharmaceutical… more
- Humana (Harrisburg, PA)
- …conducting medical necessity and comprehensive medication reviews for prescriptions requiring prior authorization . This role involves evaluating complex clinical ... until that date to be eligible to receive the payment."** **Location:** ** Remote - United States** **Schedule:** + 8-hour shifts, Monday through Friday, between… more