- CVS Health (Austin, TX)
- …compassionate. And we do it all with heart, each and every day. **Position Summary** The Manager of Prior Authorization oversees the daily operations of the ... prior authorization team, ensuring timely and accurate processing of ...United States. **Key Responsibilities:** + Lead and manage the prior authorization team, including hiring, training, scheduling,… more
- Community Based Care of Brevard, Inc. (Orlando, FL)
- Salary: $65,000/year Position Summary: The UM Program Manager provides oversight and management of service authorization data validation, reporting and trend ... provider invoices, reviews line-by-line entries, and submits to finance for payment. The UM Program Manager reconciles ARGOS Dependency Cases to FSFN for… more
- Integra Partners (Troy, MI)
- The Utilization Management ( UM ) Coordinator Supervisor oversees the day-to-day operations and performance of the UM Coordinator team. This position ensures that ... teamwork across the department. Salary: $65,000/annual JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES UM Coordinator Supervisor responsibilities include but are not limited… more
- Fallon Health (Worcester, MA)
- …Twitter and LinkedIn. **Brief Summary of Purpose:** Under the direction of the Manager of Prior Authorization , communicates with contracted and ... non-contracted facilities/agencies/providers to collect pertinent prior authorization request data and disseminates information to the Authorization … more
- Molina Healthcare (Everett, WA)
- …family include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... medications safety and medication use policies). **KNOWLEDGE/SKILLS/ABILITIES** The Pharmacist, UM will be responsible for reviewing coverage determinations and… more
- LA Care Health Plan (Los Angeles, CA)
- …Preferred: Experience in Medi-Cal managed care. 1 year of experience in UM / Prior Authorization . Skills Required: Demonstrated proficiency in Medical ... support the safety net required to achieve that purpose. Job Summary The Authorization Technician II supports the Utilization Management ( UM ) Specialist by… more
- Integra Partners (Troy, MI)
- …Take accountability for overall team performance, escalating issues as needed to the UM Clinical Manager . + Ensure compliance with all regulatory, contractual, ... The Utilization Management ( UM ) Nurse Supervisor is responsible for providing direct leadership and oversight to the UM nursing team. This role ensures team… more
- Commonwealth Care Alliance (Boston, MA)
- …Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical areas, including but ... Ensures accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying...Knowledge, Skills & Abilities (must have):** + Experience with prior authorization and retrospective reviews + Proficiency… more
- Commonwealth Care Alliance (Boston, MA)
- …Director of Utilization Management * Oversees clinical decision review for services requiring prior authorization in a variety of clinical areas, including but ... (must have): * Expertise in managing utilization review processes including prior authorization , concurrent and retrospective reviews * Demonstrated ability… more
- Sharp HealthCare (San Diego, CA)
- …encompasses a patient centered care management approach that includes referral management, prior authorization , Case Management and Disease Care Management and ... Healthcare Quality (CPHQ) - National Association for Healthcare Quality; Certified Case Manager (CCM) - Commission for Case Manager Certification **Hours** **:**… more
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