- University of Miami (Miami, FL)
- …CORE FUNCTIONS: + Adhere and perform timely prospective review for services requiring prior authorization as well as timely concurrent review for continuation of ... conducts initial, concurrent and retrospective chart reviews for clinical utilization and authorization . The Utilization Review Case Manager coordinates with the… more
- University of Miami (Miami, FL)
- …Case Manager RN - Full Time The University of Miami is currently seeking a Prior Authorization Nurse Case Manager. The incumbent purose is to conduct ... + Adhere and perform timely prospective reviews for services requiring prior authorization + Follows the authorization process using established criteria… more
- Blue KC (KS)
- …available resources to promote optimal, cost-effective outcomes. Transplant only: Provides prior authorization for, coordinates, and individually manages all ... work appropriately. Additional duties for Transplant only: + Provides prior authorization of the transplant and manages...medical policy. Opens case and follows NCQA case management standards. Documents transplant authorization , issues… more
- Sutter Health (San Francisco, CA)
- …Provides medical administration support to providers by obtaining referral or prior authorizations for patients to see specialty providers. Completes referrals ... accurately and consistently with minimal supervision. In Managed Care, processes authorization and referral requests for members in coordination with health plans… more
- MD Anderson Cancer Center (League City, TX)
- …At least two years of experience as Advanced Practice Provider, in General Oncology . Prior Thoracic/Head & Neck Medical Oncology experience. *LICENSURE ... the APP Manager. Coordination of tumor board conferences: Compiles case study data discussed at tumor board meetings. Reviews...years of experience as Advanced Practice Provider, in General Oncology . Prior Thoracic/Head & Neck Medical … more
- Astellas Pharma (Pompano Beach, FL)
- …in payer coverage, healthcare payment models, and utilization management criteria (ie Prior Authorization , Step Edits, other forms of precertification), this ... area relevant to the position, such as ophthalmology/retina, urology or oncology , demonstrating a strong understanding of the specific needs and challenges… more
- MD Anderson Cancer Center (Houston, TX)
- …to comply with institutional standards, initiatives, and guidelines (ABN's, prior authorization requirements, reimbursement optimization, formulary management, ... learning experiences. * Effectively precepts other trainee-required experiences including oncology forum, research projects, grand rounds, MUEs, etc. * Collaborates… more
- Methodist Health System (Dallas, TX)
- …professional responsible for verification of medical coverage, along with notification, prior authorization , and/or pre-determination of healthcare benefits for ... initiate pre- authorization and resolve issues that arise during the prior authorizations process. Supports and promotes the vision, mission, and strategic plans… more
- Rush University Medical Center (Chicago, IL)
- …site of care. c. Assist in assessing insurance coverage and assist in prior authorization for medications (when necessary) in advance of discharge. Other ... Hematology/ Oncology * Board of Pharmaceutical Specialties Board Certification Board of Oncology Pharmacy Specialty Certification (BCOP) prior to or within 18… more
- Walmart (Orlando, FL)
- …adherence by addressing barriers and coordinating with prescribers, pharmacists, and prior authorization teams. + Monitor patient health status, assess ... in Orlando, FL, and make a meaningful impact in oncology care. As an Oncology Certified Nurse...+ Provide telephonic/video patient education, injection training, and ongoing case management for oncology therapies. + Support… more
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