- Highmark Health (Springfield, IL)
- …coverage determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by ... requests for prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to ensure claims… more
- CVS Health (Buffalo Grove, IL)
- …will be responsible for overseeing the development, maintenance, and execution of utilization management programs. This will include both the clinical content ... needed to ensure the programs are implemented correctly. Knowledge of utilization management interventions including prior authorization, step therapy, quantity… more