- The Cigna Group (MI)
- …personalized, and focused on helping the whole person. In this pivotal role, Pharmacy Prior Authorization Representatives respond to phone inquiries from ... responses to inquiries is crucial for success. As a Prior Authorization Representative , you will...+ Prior work from home experience + Prior medical or pharmacy knowledge + Reliable… more
- Corewell Health (Grand Rapids, MI)
- …customers on drug formulary guidelines, including drug formulary alternatives and prior authorization criteria. Consistently create an exceptional experience ... We are seeking a dedicated and detail-oriented Pharmacy Customer Service Representative for a...with information and education concerning the drug formulary and prior authorization (coverage determination) requests and ensuring… more
- Veterans Affairs, Veterans Health Administration (Ann Arbor, MI)
- …clarifications to a licensed pharmacist to receive from the Community Care representative . Initiates the non-formulary/ prior authorization process with the ... fax with Community Care Provider regarding initiated communications concerning non-formulary/ prior authorization medications, clarifications, or medication change… more
- Highmark Health (Lansing, MI)
- …clearly defines the medical necessity of non-formulary and prior authorization medication exception requests. Interacts with pharmacy network providers to ... requests for drug authorizations or denials. + Review of prior authorization criteria for drug products. +...billing practices through paid clams review. + Participate as pharmacy representative in onsite member appeals and… more
- Veterans Affairs, Veterans Health Administration (Detroit, MI)
- …to direct appropriate medication therapy and adjudicate non-formulary and formulary with prior authorization medication requests Function as a mid-level provider ... for medication therapy management services. Responsibilities VA Careers - Pharmacy : https://youtube.com/embed/Fn\_ickNBEws Duties include but are not limited to:… more
- Henry Ford Health System (MI)
- …with personnel at the clinic site + Communicating with insurance payors regarding authorization issues. May be the hospital representative at external meetings ... denial or with high charges are verified for accuracy prior to claim submission + Managing authorization ...a full suite of home health offerings, virtual care, pharmacy , eye care and other health care retail. With… more
- Option Care Health (Lansing, MI)
- …facing responsibilities. **Basic Qualifications** + Knowledge of insurances (Benefit Verifications/ Prior Authorization ), in specialized pharmacy therapies ... Summary:** The Specialist, Pharma Support Services serves as the designated representative on their assigned program(s) to ensure delivery of the referral… more
- Cardinal Health (Lansing, MI)
- …care and timely access to necessary services + Assist in obtaining insurance, prior authorization , and appeal requirements and outcomes + Help patients ... streamline patient onboarding, qualification and adherence. Our non-commercial specialty pharmacy is centralized at our custom-designed facility outside of Dallas,… more
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