- Molina Healthcare (Augusta, GA)
- …Services (CMS) standards. * Provides coordination and processing of pharmacy prior authorization requests and/or appeals. * Explains point-of-sale claims ... not limited to: formulary information, copay amounts, pharmacy location services and prior authorization outcomes. * Assists members and providers with… more
- Hunterdon Health Care System (Flemington, NJ)
- …conducted through the application of evidence-based criteria or guidelines, and through authorization / prior authorization under the provisions of an ... Associates Degree or Diploma, RN must provide proof of enrollment in a BSN program prior to hire, be continuously enrolled and complete within 5 years of hire date… more
- US Tech Solutions (May, OK)
- …inpatient hospital experience . Registered Nurse in state of residence . Must have prior authorization utilization experience . Able to work in multiple IT ... EXP, pref. knowledge of Milliman/MCG. . MUST HAVE 6 months of Prior Authorization . Education: . Active and unrestricted RN licensure in state of residence… more
- US Tech Solutions (RI)
- …experience required. + Must have experience with Medcompass + Must have prior authorization utilization experience. + Managed Care/Medicare experience preferred. ... EXP, pref. knowledge of Milliman/MCG. + MUST HAVE 6 months of Prior Authorization . **Education:** + RN with current unrestricted state licensure **About US Tech… more
- University of Colorado (Denver, CO)
- …Assistant II level:** + Process basic referrals and imaging study orders. + Process prior authorization requests. + Train and onboard newly hired MAs. + ... electronically document medications within scope (ie, Depo-Provera) with provider authorization . + Administer immunization, maintain immunization records, and complete… more
- Corewell Health (Grand Rapids, MI)
- …3) Act proactively on member's behalf with routine benefits, gaps in care and prior authorization processes. 4.) Works directly with members with rising risk or ... proactively on member's behalf with routine benefits, gaps in care and prior authorization processes. + Works directly with members with rising risk or… more
- Atlantic Health System (Summit, NJ)
- …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 clinical questions and treatment/therapy plan order entry + Develops and reviews treatment/therapy plans +… more
- The County of Los Angeles (Los Angeles, CA)
- …response team. + Assists Psychiatrists in completing and checking for accuracy on Treatment Authorization Request (TAR) and Prior Authorization (PA) forms. + ... needs of the service are met and is subject to closure without prior notice. TYPE OF RECRUITMENT Open Competitive Job Opportunity DEFINITION Provides specialized… more
- CDPHP (Latham, NY)
- …professionalism. This position supports timely determination turnaround times on all prior authorization requests and inpatient notifications received via ... decision making to determine the appropriate action to take prior to logging and routing requests for authorization... prior to logging and routing requests for authorization to the appropriate clinical reviewer. CSS reviews clinical… more
- The County of Los Angeles (Los Angeles, CA)
- …response team. + Assists Psychiatrists in completing and checking for accuracy on Treatment Authorization Request (TAR) and Prior Authorization (PA) forms. + ... until the need of the service are met and is subject to close without prior notice The LA County Board of Supervisors recently declared a local state of emergency… more