- UCLA Health (Los Angeles, CA)
- …and resolving simple and complex patient/provider issues related to the authorization and claims process. You will also conduct performance evaluations, counsel ... processing ambulatory commercial, Medicare Fee for Service, and Medicare Advantage prior authorizations desired + Knowledge of the HMO referral process, eligibility… more
- Truman Medical Centers (Kansas City, MO)
- …patient and family. Ask key questions and correctly and rapidly facilitate the prior authorization and scheduling process for outpatient patients, by ensuring ... into myWORKDAY (http://www.myworkday.com/trumed/d/home.htmld) to search for positions and apply.** Utilization Specialist Team Lead 101 Truman Medical Center **Job… more
- Fallon Health (Worcester, MA)
- …expectations. The FH Authorization Coordinator serves to administer the FH prior authorization process as outlined in the Plan Member Handbook/Evidence of ... when the authorization meets the criteria listed in the appropriate Prior Authorization Protocol, authorizations not meeting protocol parameters are prepared… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …course work preferred **Work Experience** + 1 year call center experience or prior knowledge of a health insurance pre-service authorization required **Skills ... This role does not manage people + This role reports to this job: SUPERVISOR , CLINICAL INQUIRY + Necessary Contacts: All levels of BCBSLA personnel, providers, and… more
- Cuyahoga County Board of Developmental Disabilities (OH)
- …to ensure fiscal responsibility including: use of Cost Projection Tools, the Prior Authorization Review Process, implementation of AAI Administrative Review, and ... of Developmental Disabilities (Cuyahoga DD) is seeking a new Supervisor to plan, organize and supervise all Service and... utilization of Medicaid State Plan Services. Deliver technical assistance… more
- Children's Hospital & Research Center Oakland (Oakland, CA)
- **Position Summary:** The primary role is to supervise the Utilization Management, Surgery Registration, and Financial Counselors activities to insure a payor source ... is identified prior to or within 24 hours of an admission....payors to insure all services provided are reimbursed. The Supervisor provides the necessary support and leadership to achieve… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …as needed. * Serves as subject matter expert (SME) for non-clinical authorization activities within the utilization management department. * Conducts quality ... About The Role The UM Coordinator Supervisor manages the daily operations of the UM...UM Coordinator team providing direct guidance and support with authorization creation, caller escalation and investigation of complex cases.… more
- Air National Guard Units (Lincoln, NE)
- Summary This National Guard position is for a AIRCRAFT MAINTENANCE SUPERVISOR , Position Description Number D1444000 and is part of 155 MXS, Nebraska Air National ... WITH AGR ANNOUNCEMENT AGR-AF-25-006 Responsibilities As a AIRCRAFT MAINTENANCE SUPERVISOR , WS-8801-14, duties include: (1) Planning: Plans the overall allocation… more
- Whole Foods Market (Union, NJ)
- …We think you'll agree that it's a great time to join #TeamWFM. The Supervisor , WFMOA: E-Commerce requires you to lean into five key areas: safety, quality, customer ... all Team Members. + Reviewing the work forecasts and uphold productivity and utilization requirements to meet the overall WFMOA objectives. + Partnering with other… more
- Commonwealth of Pennsylvania (PA)
- …Minimum Experience and Training Requirements: + Two years as a Registered Nurse Supervisor or three years as a Registered Nurse Instructor (commonwealth titles) in a ... illness, or developmental disability. Special Requirements: + This position requires active authorization to practice as a Registered Nurse in Pennsylvania. + All… more
- Kepro (AR)
- …There is no required Travel for this role. ** Job Summary: + Completes prior authorization , continued stay, and retroactive and retrospective quality reviews for ... accreditation/regulatory standards. Job Responsibilities: + Completes initial and concurrent prior authorization and retrospective reviews for Behavioral Health… more
- Air National Guard Units (Eielson AFB, AK)
- …Air National Guard. PDCN: D2180P01 / D2181P01 MPCN: 889707 Selecting Supervisor : James Meyer Responsibilities GS-09 - Administers classified and unclassified local ... and software and develops base wide network operating procedures. Analyzes LAN utilization statistics through data collection and performance measures to ensure the… more
- University of Michigan (Ann Arbor, MI)
- …is unique in that it combines clinical/quality considerations with regulatory/financial/ utilization review demands. The position creates a balance between individual ... clinical needs with the efficient and cost effective utilization of resources while promoting quality outcomes. **Organizational Relationships** The RN Case Manager… more
- InnovaCare (San Juan, PR)
- …others as required. Performs any other job related duties as assigned by the Supervisor . General knowledge of Prior authorization criteria and pharmacy ... CMS requirements to the members and prescribing physicians. Perform system overrides (eg, prior authorization ) on the PBM claims processing system to ensure that… more
- Air National Guard Units (Hickam AFB, HI)
- …ie, a military technician may not be militarily senior to his or her full-time supervisor . b. Authorization for payment of PCS expenses will be granted only ... is to manage deployment and logistical assets to ensure productive and effective utilization of materiel funding and requirements for all Security Forces tasks and… more
- Billings Clinic (Billings, MT)
- …must complete several pre-employment requirements prior to starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) ... through risk stratification tools and ongoing assessments including ED utilization and hospitalizations to address the medical/psychosocial/financial needs of… more
- Northern Light Health (Bangor, ME)
- …to appropriate depart/office. Documenting information in Patient's chart. Processing insurance referral/ prior authorization and document this per protocol. * ... Care Organizations to gain full understanding of benefit coverage and precertification/ authorization , if appropriate * Quality review procedures are followed to… more
- Cardinal Health (New York, NY)
- …is to provide a detailed outline of clearance criteria as well as prior authorization and advocacy identification for procedures and medications scheduled to ... to representatives for benefit investigation as well as clinical clearance for prior authorization and medical necessity + Extensive patient education/counseling… more
- Northern Light Health (Hampden, ME)
- …to appropriate depart/office. Documenting information in patient's chart. Processing insurance referral/ prior authorization and document this per protocol. + ... Care Organizations to gain full understanding of benefit coverage and precertification/ authorization , if appropriate + Quality review procedures are followed to… more
- Northern Light Health (Brewer, ME)
- …to appropriate depart/office. Documenting information in Patient's chart. Processing insurance referral/ prior authorization and document this per protocol. * ... Care Organizations to gain full understanding of benefit coverage and precertification/ authorization , if appropriate * Quality review procedures are followed to… more