- CareOregon (Portland, OR)
- …Texas, Montana, or Wisconsin. Job Title Pharmacy Clinical Coordinator - ( Prior Authorization) - Contingent Exemption Status Exempt Department Pharmacy Manager Title ... pharmacy program activities as assigned. Essential Responsibilities + Prepare drug utilization reports and analyses for the Pharmacy & Therapeutics Committee. +… more
- Sanford Health (ND)
- …The Patient Access Specialist reviews and validates insurance eligibility, prior authorization and/or referral of medication, procedures, etc.; determines if ... insurance meets prior authorization criteria. Collects necessary documentation and communicates with...Documents work in case management module; provides direction to utilization management, case management, and nursing regarding what action… more
- Henry Ford Health System (Troy, MI)
- RN REFERRAL MANAGEMENT COORDINATOR (VIRTUAL) - PRIOR AUTHORIZATIONS - 40 HOURS - DAY SHIFT Full Time Benefit Eligible Schedule: Monday through Friday, 8:00AM to ... Health Alliance Plan (HAP) is looking to grow our Prior Authorization Team with experienced Registered Nurses! We are...the time of the denial and distributes to the Utilization Management Services staff for processing. + Reports on… more
- University of Utah Health (Salt Lake City, UT)
- …verification, obtaining benefit information, calculating patient estimates and obtaining prior authorization before services are rendered. This position works with ... clinic managers, and financial advocates to resolve issues that arise during the prior authorizations process. This position is not responsible for providing care to… more
- AdventHealth (New Smyrna Beach, FL)
- …qualifications:** + BSN + Health-related Master's degree or MSN + Prior Care Management/ Utilization Management experience ACM/CCM Certification This facility ... of the implementation of the transitions of care plans prior to the discharge of the patient. The RN...physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge… more
- Actalent (Eagan, MN)
- …responsibility will be leveraging your clinical skills to complete utilization management (UM) reviews-including prior authorizations, coverage exceptions, ... of your home? Join a dynamic team where your expertise powers critical utilization management decisions that directly affect patient care. This is more than just… more
- AdventHealth (Deland, FL)
- …qualifications: + BSN + Health-related Master's degree or MSN + Prior Care Management/ Utilization Management experience ACM/CCM Certification This facility ... of the implementation of the transitions of care plans prior to the discharge of the patient. The RN...physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge… more
- Centene Corporation (New York, NY)
- …a fresh perspective on workplace flexibility. **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service and ... teams, to assess medical necessity of care of member + Escalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of… more
- Molina Healthcare (Albuquerque, NM)
- …and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare ... members. + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information… more
- Elevance Health (Tampa, FL)
- **Manager I Medical Management ( Prior Authorizations) - Florida Medicare** **Office Locations:** This role is based in Florida at either our Tampa or Miami ... as required by law._ The **Manager I Medical Management ( Prior Authorizations)** is responsible for managing a team of...RN license is strongly preferred. + 5+ years of utilization management experience strongly desired. + Exposure to Overpayment… more