- Fallon Health (Worcester, MA)
- …expectations. The FH Authorization Coordinator serves to administer the FH prior authorization process as outlined in the Plan Member Handbook/Evidence of ... when the authorization meets the criteria listed in the appropriate Prior Authorization Protocol, authorizations not meeting protocol parameters are prepared… more
- Point32Health (MA)
- …requests + Achievement of expected productivity goals + Review of all assigned prior authorization requests including but not limited to inpatient admissions, ... referrals, outpatient procedures, VNA or outpatient therapies as specified in the prior authorization list using specified clinical criteria sets. + Concurrent… more
- Point32Health (Canton, MA)
- …responsible for reviewing, processing and managing the daily caseload of pharmacy prior authorization (PA) requests for coverage determinations (CD), and ... . **Job Summary** Under the direction of the Pharmacy Utilization Management (UM) Supervisor , the Clinical Pharmacist...consults as required with THP Medical Directors (MD) on prior authorization that fails to meet drug… more
- Beth Israel Lahey Health (Westwood, MA)
- …and master an understanding of product and payer reimbursement landscape and prior authorization guidelines and processes. Collects and communicate all data ... needed to facilitate prior authorization approvals. Convey status updates as...not limited to), delivery, vaccination, synchronization and mobile app utilization . + Handle returns of merchandise and immediately notify… more
- Cardinal Health (Boston, MA)
- …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
- East Boston Neighborhood Health Center (Revere, MA)
- …review referrals and claims-related data in an effort to provide utilization reports to other departments. Insurance Department: * Must maintain up-to-date ... of Coordination of Benefits. * In conjunction with the Supervisor of Business Services, responsible for assisting with and...are correctly categorized and reported. + Oversees the referral authorization process as it relates to timely and accurate… more