- Dignity Health (Rancho Cordova, CA)
- …the appropriate application of policies and guidelines to Managed Care prior authorization referral requests. Under general supervision this position is responsible ... Supervises the use of established criteria sets (Medicare Guidelines InterQual Health Plan Benefit Interpretation Guidelines and Medical Management Policies and DHMF… more
- Intermountain Health (Columbus, OH)
- …practices and processes. + Promotes mission, vision, and values of Intermountain Health , and abides by service behavior standards. + Delivers detail-oriented, ... and Intermountain Health . + Provides delivery of medications, information, and service in a professional, timely manner and is actively engaged in department and… more
- CVS Health (Honolulu, HI)
- At CVS Health , we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming ... health care. As the nation's leading health ...This position provides processing and communication of Specialty medication prior authorization referrals reviewed by the Case Review Unit… more
- US Tech Solutions (May, OK)
- …data needed to perform clinical assessments and reviews as per the health plan/employer-agreed criteria within the designated service level agreements. Performs ... role that conducts clinical reviews of medical data collected to perform prior authorization for commercial and specialty medications. + The clinical pharmacist will… more
- University of Texas Rio Grande Valley (Edinburg, TX)
- …FTE1.0 FLSANon-Exempt Scope of Job Responsible for obtaining and processing all prior authorizations and referrals and entering the completed referral into the ... ensure services are validated. Description of Duties + Processes prior authorizations and referral requests in a timely manner,...+ Obtains and receives referral requests from providers and health plans related to services for patient visits and… more
- Montrose Memorial Hospital (Montrose, CO)
- …they facilitate the process from provider through payer to patient for timely health care diagnostics and treatments. The Prior Authorization Specialist supports ... including vacation, sick and holiday pay. About Montrose Regional Health : + As the leading healthcare in the Uncompahgre...standards of healthcare. About The Career: + The Hospital Prior Authorization Specialist is an advocate for the patient's… more
- University of Rochester (Rochester, NY)
- …data and ensures compliance to enterprise standards and referral and prior authorization guidelines. Communicates regularly with patients, families, clinical and ... follow up. Adheres to approved protocols for working referrals and prior authorizations. **ESSENTIAL FUNCTIONS** + Responsible for managing department referrals. +… more
- US Tech Solutions (May, OK)
- …medical data needed to perform clinical assessments, and reviews as per the health plan/employer agreed criteria within the designated service level agreements. ... regarding Prior Authorization + Establishes and maintains communication among, health plan and employer group staff. + Maintain professional and technical… more
- AscellaHealth (Berwyn, PA)
- …This critical role manages the process of receiving, researching, and resolving prior authorizations and appeals issues with health insurance companies, ... What we are looking for Optime Care seeks a Prior Authorization and Appeals Specialist for our Berwyn, PA...to compliance and education. Every patient receives a proactive service experience tailored to their specific needs. AscellaHealth provides… more
- Veterans Affairs, Veterans Health Administration (Tuskegee, AL)
- …Selected applicants may qualify for credit toward annual leave accrual, based on prior [work experience] or military service experience. Parental Leave: After 12 ... Selected applicants may qualify for credit toward annual leave accrual, based on prior work experience or military service experience. This credited service… more
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