- Elevance Health (Grand Prairie, TX)
- …of all prior authorization determinations. + Provides resolution to grievances and appeals issues. + Responds to inquiries from physicians, sales team, and members ... formulary and prescription benefits. + Generates reports relating to rebates, physician utilization , Beers Criteria, Reliance members, and other ad hoc reports. +… more
- Elevance Health (Houston, TX)
- …Medical Director** **Carelon Medical Benefits Management** **Radiology Benefit Management/ Utilization Review** **Virtual:** This role enables associates to work ... for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures consistent use of medical… more
- The Cigna Group (Austin, TX)
- …terminology, specialty injectable medications, Cigna Coverage Review Department (CCRD), appeals , and/or utilization management + Familiarity with project ... Advisor Role Summary:** Reporting to the Gene and ACT Clinical Program Senior Manager , the Program Advisor plays a key role in ensuring strategic, operational, and… more
- Elevance Health (Grand Prairie, TX)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… more