- Centene Corporation (Tallahassee, FL)
- …organization offering competitive benefits including a fresh perspective on workplace flexibility. Pharmacy Coordinator - (Grievances, Appeals , and Prior ... + Grievances, Appeals , and Prior Authorizations + Processing Pharmacy Appeals from Medicaid and Ambetter LOBs (Sunshine Health/FL Marketplace) + Place… more
- Commonwealth Care Alliance (Boston, MA)
- …operations, pharmacy , dental, reporting, and member services. - Supports the Senior Appeals & Grievance Coordinator and A/G Coordinator in day-to-day ... **Why This Role is Important to Us:** Appeals and Grievances Representative supports the Operations Department...and Grievances Representative supports the Operations Department and the Appeals and Grievances team in a number of ways… more
- Medical Mutual of Ohio (OH)
- …Medicare Part D experience is highly sought after._** **Responsibilities** **Medicare Pharmacy Coordinator I** Working under general supervision, administers ... drug) programs as needed. . Performs other duties as assigned. **Medicare Pharmacy Coordinator II** Working under general supervision, administers standardized… more
- Omnicell (Grapevine, TX)
- **Summary** The OSPS (Omnicell Specialty Pharmacy Services) Pharmacy Audit and Credentialing Coordinator supports the OSPS PSAO through various functions, ... a support role. + Provide education and guidance to pharmacy staff on audits, rejections, and MAC Appeals... pharmacy staff on audits, rejections, and MAC Appeals when appropriate. + Complete required information for various… more
- Highmark Health (Harrisburg, PA)
- …coordination of benefit billing practices through paid clams review. + Participate as pharmacy representative in onsite member appeals and grievances sessions. + ... job provides front line staff guidance, ensures effective and efficient delivery of Pharmacy call center services. Serves as first line reviewer in monitoring and… more
- AbbVie (North Chicago, IL)
- …in the healthcare industry with knowledge in reimbursement, billing, prior authorization, appeals , and specialty pharmacy operations. + 1-2 years supervisory ... Facebook, Instagram, YouTube and LinkedIn. Job Description The Patient Care Coordinator Supervisor provides leadership, support, and supervision for the team. This… more
- HonorHealth (Scottsdale, AZ)
- …at HonorHealth.com. Responsibilities Job Summary The Research Infusion Authorization Coordinator I position within the HonorHealth Research Institute initiates and ... organizing workflow, tracking critical information, and contacting physicians and pharmacy staff for required documentation. Verifying insurance eligibility and… more
- Mohawk Valley Health System (Utica, NY)
- Registered Nurse - MDS Coordinator - Regular Hours - Days Department: UTILIZATION SERVICES Job Summary The RN - MDS Coordinator will play a crucial role in ... end of Medicare MDS when appropriate. Notifies billing, interdisciplinary care team and pharmacy of any changes. + Monitors for any resident changes in condition… more
- BrightSpring Health Services (Atlanta, GA)
- …Payee to Client Trust Fund* Responsible for working with Client Trust Fund Coordinator at the Austin* Business Center to set up RFMS Account* Assure individuals ... Medicaid Redetermination for each individual annually or as needed* Files Medicaid Appeals when required within 30-day time frame of decisions* Notifies Medicaid or… more
- Rush University Medical Center (Chicago, IL)
- …Qualifications:** *Associate's degree from an accredited college/university *Healthcare/ pharmacy experience desired. *CPR+ experience **Competencies:** *Computer ... path to obtain authorization and patient's financial responsibility. 5. Submits appeals for authorization denials. 6. Serves as resource to navigators regarding… more
- Cardinal Health (Columbus, OH)
- …that fully integrates direct drug distribution to site-of-care with non-commercial pharmacy services, patient access support, and financial programs, Sonexus Health, ... to confirm approval/denials of coverage, co-pays and verification of specialty pharmacy that will dispensing their medication * Contact insurance companies as… more
- Louisiana Department of State Civil Service (Houma, LA)
- …administration, public health administration, social services, nursing, pharmacy , dietetics/nutrition, physical therapy, occupational therapy, medical technology, ... nursing home administration, public health administration, social work, nursing, pharmacy , dietetics, nutrition, physical therapy, occupational therapy, or medical… more
- Veterans Affairs, Veterans Health Administration (Seattle, WA)
- …a complex nature such as nuclear pharmacy , quality assurance, pharmacy informatics, clinical applications coordinator , Home Based Primary Care, ... Puget Sound Health Care System. Responsibilities VA Careers - Pharmacy : https://youtube.com/embed/Fn\_ickNBEws The Formulary Program Manager has the primary… more
- City and County of San Francisco (San Francisco, CA)
- …+ Zuckerberg San Francisco General Hospital & Trauma Center (ZSFG) Inpatient Pharmacy + Zuckerberg San Francisco General Hospital & Trauma Center (ZSFG) Outpatient ... Pharmacy + Zuckerberg San Francisco General Hospital & Trauma...Francisco General Hospital & Trauma Center (ZSFG) 340B Program Coordinator + San Francisco County Jails, both in San… more
- State of Colorado (Denver, CO)
- …sets; + Demonstrated experience working with data sets, including claims and/or pharmacy data, in the commercial (private) and/or public health insurance industry; + ... this position, please direct your inquiries to our ADAAA Coordinator , at dora_###@state.co.us . Check out our excellent benefits...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Pueblo, CO)
- …standards and regulations to include but not limited to: DSM, Pharmacy Formulary, Treatment Plans, Infection Control Manual, Physicians Orders, Court orders, ... of the department's action. For more information about the appeals process, the official appeal form, and how to...this position, please direct your inquiries to our ADAA Coordinator , Nancy Schmelzer, at cdhs_###@state.co.us or call ###. ~THE… more
- State of Colorado (Denver, CO)
- …CMHIP, etc.) Perform entries into various security-sensitive areas (After-Hours Pharmacy , Central Medical Supply, Medical Records, Finance/Safe, etc.) with/without ... of the department's action. For more information about the appeals process, the official appeal form, and how to...this position, please direct your inquiries to our ADAA Coordinator , Nancy Schmelzer, at cdhs_###@state.co.us or call ###. ~THE… more
- State of Colorado (Grand Junction, CO)
- …of notice or acknowledgement of the department's action. For more information about the appeals process, the official appeal form, and how to deliver it to the State ... and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, at spb.colorado.gov under Rules. Supplemental Information How… more
- Hackensack Meridian Health (Hackensack, NJ)
- …ortho calls, payer communications and support of the Care Coordinators. Prepares required Appeals and Denial information for processing and follows up on receipt of ... Hackensack Meridian _Health_ includes: + In collaboration with the Care Coordinator , reviews daily admission data to verify inpatient insurance coverage, pre-certs,… more