- CentraCare (St. Cloud, MN)
- …and report quality indicators, required activities of utilization review, payer certification processes, and to identify performance improvement opportunities. ... Follows the guidelines of the Utilization Review Plan to assure cost-effective care and fulfills the requirement of the Center of Medicare and Medicaid Services Conditions of Participation (CoP) Utilization Review. Schedule: + Part-time | 48 hours every two… more
- CareFirst (Baltimore, MD)
- …and government programs plans and experience administering plans in a large payer organization is helpful. + Overall technical knowledge and understanding of Guiding ... Care, Facets, and other key systems as well as how to navigate through compliance requirements is helpful.Ability to work across multiple business areas, collaborate with peers, clinical, clinical support, medical director, and other levels while ensuring… more
- Atlantic Health System (Summit, NJ)
- …Review all new therapy plan starts to facilitate drug therapy review and payer coverage + Coordinate initiatives to assist with optimizing drug selection including ... biosimilar management and utilizing feedback from prior authorization team + Assist prior authorization to locate references when needed to support off-label therapies + Review/monitor inpatient and outpatient chemotherapy regimens + Assist providers with… more
- St. John's Embrace Living (Rochester, NY)
- …to provide support to residents and families, as well as maintain census and payer mix. Qualifications & Education Required: + Bachelor's Degree in Social Work or ... Human Services OR Bachelor's Degree in Nursing or NYS RN Licensure OR Licensed Practical Nurse (LPN), with a minimum of three years' experience in LTC with experience with the admissions process + Preference for at least 2 years of experience in a skilled… more
- Hartford HealthCare (Farmington, CT)
- …and reporting of revenue and compliance with government and third-party payer requirements. Assesses the accuracy of all charging vehicles, including clinical ... systems and dictionaries, encounter forms and other charge documents used to capture revenue 2) Analyzes denial data to identify root causes of preventable denials, develop and implement corrective action plans to address root causes, including collaborating… more
- Albany Medical Center (Albany, NY)
- …or Physician office experience, preferred Strong insurance knowledge regarding payer contract interpretation including Authorization Requirements and Setting of Care ... Skills, Knowledge & Abilities: Proven customer service skill with ability to exceed expectations Ability to multi-task in stressful and high patient volume unit; must be able to manage pressure of very tight timeframes to execute task Strong understanding of… more
- Catholic Health Services (West Islip, NY)
- …provide necessary coaching if needed. + Escalate insurance authorization delays to payer leadership and or hospital leadership Competencies: + Time Management + ... Listening skills + Verbal and Written Communication skill + Prioritizing + Organizing + Computer skills Skills + Proficient in the use of a personal computer - including standard office software Word , Excel ; experience with basic file and directory… more
- Cornell Scott Hill Health Corporation (New Haven, CT)
- …state, federal, professional, hospital, and health center accrediting and health payer entities. + Actively pursues continuing education opportunities to maintain ... knowledge and skills. Qualifications: Education: Degree from an accredited Optometry School. Must have current Basic Life Support Certification. Experience: Board Certification or Board Eligibility. Active Connecticut Licensure. As part of the Cornell… more
- J&J Family of Companies (Horsham, PA)
- …and beliefs, the presence or absence of support networks, provider and payer dynamics, and socioeconomic factors. For many patients, the decision to start ... or stop a treatment is overwhelming. Johnson & Johnson Innovative Medicine recognizes this, and wants to create an experience that is personalized, helpful, and hopeful. **Primary Responsibilities:** + Analysis of Fulfillment Metrics deployment/execution… more
- Prime Healthcare (Chicago, IL)
- …be able to demonstrate understanding of and ability to interpret third party payer principles and terms and COBRA laws. Strong organizational skills required for ... effective communication with patients, physicians, public, staff and administrations. Must be able to work in fast paced environment with frequent interruptions. + Knowledge of medical terminology preferred. + Effective written, verbal communication, and… more