- 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)
- …complete ongoing reviews for clinical utilization and identifying the need for continued authorization . The Utilization Case Manager coordinates with the Nurse ... team for optimal patient outcomes, while avoiding potential treatment delays and authorization denials. The Utilization Case Manager is accountable for a… 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
- GE HealthCare (Remote, OR)
- …support three patients every second around the world. This role is for the Oncology division and will work directly with the commercial team for additional expertise ... on breast cancer and clinical adoption of Cerianna. Oncology is a priority care area for us where...ensure clinical acceptance of Cerianna. + Follow up of prior educated customers to ensure long term acceptance and… more
- MD Anderson Cancer Center (Houston, TX)
- …Preferred: At least 1 year of experience in Advanced Practice Provider role. Prior Oncology experience. **LICENSURE / CERTIFICATION** Required: All of the ... Preferred: At least 1 year of experience in Advanced Practice Provider role. Prior Oncology experience. **LICENSURE / CERTIFICATION** Required: All of the… more
- Pfizer (San Diego County, CA)
- …but not limited to project teams, peers, partner lines and ORU ( Oncology Research Unit) leadership, you will be responsible for successfully leading research ... and coordinating experimental plans across group to support the business units' case for investment for continued investment. + Actively contribute to the broader… more
- CVS Health (Phoenix, AZ)
- …**Required Qualifications** + 1+ year: Oncology and Transplant UM, concurrent review or prior authorization + 3+ years: acute clinical Oncology or ... within Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical… more
- LifePoint Health (Johnstown, PA)
- CPP Medical Specialties is seeking a full-time Scheduler - CPG Medical Oncology in Johnstown, PA. The Scheduler is responsible for coordinating patient's procedures ... in use of EPIC system for placing orders/prep for case and documenting needed information in appropriate place. This...Responsible for obtaining correct CPT and ICD 10 codes prior to obtaining authorizations for procedures. Will work with… 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
- Beth Israel Lahey Health (Boston, MA)
- …for patients from referral/consultation to discharge /follow up. Assists with pre- authorization process. 2. Serves as contact and facilitator to receive consults ... of patient/family educational materials. Participates in patient rounds and case conferences. 5. Updates clinical knowledge and skills through consultation,… more
- University of Washington (Seattle, WA)
- Req #: 240792 Department: DEPARTMENT OF MEDICINE: HEMATOLOGY & ONCOLOGY Appointing Department Web Address: https://hemonc.uw.edu Job Location Detail: Will consider ... pursuits, and natural beauty. **The Division of Hematology and Oncology has an outstanding opportunity for a Clinical Trial...Leads to design, create and revise research instruments (eg case report forms and source documents) as necessary to… more
- University of Washington (Seattle, WA)
- Req #: 239618 Department: DEPARTMENT OF MEDICINE: HEMATOLOGY & ONCOLOGY Appointing Department Web Address: https://hemonc.uw.edu/ Job Location Detail: Fred ... pursuits, and natural beauty. **The Department of Hematology and Oncology has an outstanding opportunity for a Clinical Trial...guidelines. + Design, create and revise research instruments (eg case report forms) as necessary to ensure quality data… 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
- Independent Health (Buffalo, NY)
- …quality, professional utilization management services: (medical necessity review for Prior Authorization , pre-certification, and concurrent review). + Prompt, ... in the day-to-day management of the RN staff of their assigned area ( Case Management, Utilization Review and Population Health). This will include monitoring the… more
- Amgen (Tacoma, WA)
- …on TEPEZZA coverage based on their benefits and the steps needed to gain prior authorization to ensure understanding of the process for medication access + ... upon patient enrollment on coverage for Horizon rare disease therapies, common prior authorization requirements, and coding and billings requirements + Provide… more
- Amgen (Minneapolis, MN)
- …on KRYSTEXXA coverage based on their benefits and the steps needed to gain prior authorization to ensure understanding of the process for medication access** ... patient enrollment on coverage for Horizon rare disease therapies, common prior authorization requirements, and coding and billings requirements** **.Provide… more
- AbbVie (North Chicago, IL)
- …groups to develop creative solutions to challenging patient access issues regarding prior authorization , financial situations and denied coverage requests to ... of experience in the healthcare industry with knowledge in reimbursement, billing, prior authorization , appeals, and specialty pharmacy operations. + 1-2 years… more
- Avera (Sioux Falls, SD)
- …government programs. A successful advocate will communicate with patients, families, case managers, and providers to assess care plans and corresponding coverage ... applications for drug assistance. Provide accurate cost estimate details to patients prior to appointments. + Discuss benefits and other financial concerns with… more
- The Cigna Group (Baltimore, MD)
- …and Coordination** 1. Participation in weekly care coordination with health plan case management as directed by market needs 2. Referral Management Care Coordination ... hrs. of order placement **Diagnostics and Lab Result Management** 1. Obtain Pre Authorization for all CT, MRI, Echo's ordered by providers (Pt Coordinators to… more
- The Cigna Group (Houston, TX)
- …and Coordination** 1. Participation in weekly care coordination with health plan case management as directed by market needs 2. Referral Management Care Coordination ... 24 hrs. of order placement **Diagnostics and Lab Result Management** 1. Obtain Pre Authorization for all CT, MRI, Echo's ordered by providers and schedule patient 2.… more