- Commonwealth Care Alliance (Boston, MA)
- …Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical areas, including but ... 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager...Knowledge, Skills & Abilities (must have):** + Experience with prior authorization and retrospective reviews + Proficiency… more
- Point32Health (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...guidelines. **Job Description** + Performs case reviews in automated prior authorization (Auto PA) tools and guides… 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
- Children's Hospital Boston (Boston, MA)
- …or instructions from supervisor as necessary. + Schedules any consults needed prior to the surgery as requested, ie cardiac clearance. + Monitors Epic for ... evaluate scheduling procedures and develop strategies to promote efficient utilization of surgical suites. May coordinate surgical cases for...insurance authorization for the procedures. + Brings high priority issues… more
- Air National Guard Units (Otis Ang, MA)
- …to ensure success in meeting goals and objectives. Provides advice to supervisor on significant issues and problems related to work accomplishment. Establishes ... a detailed and comprehensive report with any corrective action taken to supervisor . Follows-up to ensure complete and quality resolution of discrepancies. Assesses… more
- Air National Guard Units (Westfield, MA)
- …to ensure success in meeting goals and objectives. Provides advice to supervisor on significant issues and problems related to work accomplishment. Establishes ... detailed and comprehensive reports with any corrective action taken to supervisor . Follows-up to ensure complete and quality resolution of discrepancies. Assesses… more