- UPMC (Tobyhanna, PA)
- …and policies and procedures, in regards to services. + Utilizes supervision with medical director and clinical manager regularly. + Participates in CQI ... on-site presence in the office as needed. The ideal candidate will have prior experience working with children, adolescents and IBHS. A Care Manager is responsible… more
- Monte Nido (Miami, FL)
- …+ Complete and manage all authorizations for designated programs & departments including prior authorization , continued stay, change in level of care, discharge, ... from a multi-disciplinary treatment team approach while integrating state-of-the-art medical , psychiatric, nutritional, and clinical strategies to provide comprehensive… more
- Integra Partners (Troy, MI)
- …policies). + Review and process clinical and administrative appeals; coordinate with Medical Director when required. + Generate and review daily/weekly reporting ... + Experience with Medicare and Medicaid requirements. + Familiarity with DMEPOS authorization and appeals processes. + Knowledge of medical necessity criteria… more
- Silver Bay Carefree Living By Oxford Living (Silver Bay, MN)
- …in care conferences as necessary. Monitor client's funding sources to assure that prior authorization is obtained and transferred accurately and timely to the ... prior Authorization Department and that the appropriate...Perform other functions as deemed appropriate by the Executive Director or Regional Manager of Operations. Market the wide… more
- Sharp HealthCare (La Mesa, CA)
- …referrals for care and services are directed to appropriate network providers, and obtains prior authorization for in network and out of network services as ... venues.Escalate and refers cases for consultation with Physician Advisor or Medical Director as appropriate.Oversee preparation, delivery and documentation of… more
- State of Colorado (Denver, CO)
- …while also keeping them safe. The State of Colorado offers competitive medical , dental and vision insurance, life and disability insurance, and flexible spending ... facilities and has responsibility for acceptance of critical structural components prior to delivery to the construction site; is responsible for inspection… more
- University of Rochester (Rochester, NY)
- …access drugs in assigned clinics. Collaborates with clinical staff to acquire prior authorization for relevant providers, investigates benefits, enrolls patients ... major payers for the relevant clinic-administered drugs that require prior authorization (PA) and is responsible for...of medical necessity is needed or if physician-to- medical director conversation is needed for approval… more
- Penn Medicine (Plainsboro, NJ)
- …manner. The diagnostic supervisor will work collaboratively with the radiology associate director , radiology director , medical staff, and administration to ... leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across… more
- Penn Medicine (Philadelphia, PA)
- …proper scheduling of services to be performed. When applicable coordinates with the prior authorization staff to verify benefits and obtain any necessary ... leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across… more
- Immigration and Customs Enforcement (Houston, TX)
- …Operations (ERO), ICE Health Service Corps (IHSC), Office of Deputy Assistant Director of Health Systems Support (DAD-HSS), Health Operations Unit (HOU). This is ... policies, accreditation standards, laws, and regulations. Collaborates with the RHA, Clinical Director , and Nurse Manager, as a function of the leadership Triad, to… more