- CVS Health (Hartford, CT)
- …Utilization management - The medical director will perform concurrent and prior authorization reviews with peer to peer coverage of denials. * Appeals - ... behavioral health programs and services to its membership. Aetna is looking for a medical director to be part of a centralized team that supports the Medical … more
- CVS Health (Springfield, IL)
- …Account Management in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities ( prior authorization and ... Summary** CVS Health, a Fortune 6 company, has an outstanding opportunity for a Medical Director ( Medical Affairs). This is a remote based, work from home… more
- Fallon Health (Worcester, MA)
- …follow us on Facebook, Twitter and LinkedIn. **Brief Summary of Purpose:** The Manager, Prior Authorization RN manages all staffing and activities related to ... prior authorization which includes but is not...problems lacking clear precedent are usually reviewed with the Director , UM and PA prior to taking… more
- University of Utah (Salt Lake City, UT)
- …, CPT codes and related medical records are submitted in the authorization request. Secures prior authorizations for outpatient imaging and in office ... Details **Open Date** 08/06/2025 **Requisition Number** PRN42768B **Job Title** Prior Authorization Representative I **Working Title** Prior Authorization… more
- University of Utah (Salt Lake City, UT)
- …Number** PRN42803B **Job Title** PS Coordinator, Scheduling **Working Title** Coordinator, Prior Authorization **Job Grade** C **FLSA Code** Nonexempt **Patient ... Medicine has an immediate opening for a Scheduling and Prior Authorization Coordinator. This position works with...2. Ensures accurate ICD , CPT codes and related medical records are submitted in the authorization … more
- Dana-Farber Cancer Institute (Brookline, MA)
- …+ Discusses complex medical necessity cases in all aspects of the prior authorization work (on-label drug, off-label drug, laboratory testing, and others as ... environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve as a liaison and… more
- LA Care Health Plan (Los Angeles, CA)
- …in Medi-Cal managed care. 1 year of experience in UM/ Prior Authorization . Skills Required: Demonstrated proficiency in Medical Terminology required. Strong ... such as submitting requested information in a timely manner and using the approved Authorization Request form with complete medical information ie: ICD 10 codes,… more
- CVS Health (Austin, TX)
- …do it all with heart, each and every day. **Position Summary:** Ready to take your Medical Director skills to the next level with a Fortune 6 company? Checkout ... Ohio, Oklahoma, Pennsylvania, Texas, Virginia and West Virginia. This Medical Director will be a "Work from...This position is primarily responsible for Utilization Management, including prior authorization and precertification as well as… more
- Commonwealth Care Alliance (Boston, MA)
- …with the needs of the populations. + Evaluate the effectiveness of the company's medical policies and prior authorization program in collaboration with other ... 011200 CCA-Central Clin Ops Leadership **Position Summary:** Reporting to the Sr. Medical Director of Utilization Management (UM) and Policy, the Medical … more
- CVS Health (Topeka, KS)
- … medical license without encumbrances in one of these states.** + In the Medical Director role you will provide oversight for medical policy ... consistent responses to members and providers. + As a Medical Director you will focus primarily on...reviews and review of claim determinations. + This includes Prior Authorization / Pre Certification / Concurrent… more
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