- Christus Health (Irving, TX)
- …to ensure timely review and processing of orders. Oversees the prior authorization and appeals process. Offers clinical assistance to the technician staff as ... have the necessary skills before sending an application. Summary: The Specialty Clinical Pharmacist is responsible and accountable for the provision of safe,… more
- CVS Health (Richmond, VA)
- …to Applied Behavior Analysis (ABA). * Provide daily support and guidance to the ABA prior authorization clinical team and health plan medical directors. ... system that is transparent, consumer-focused, and acknowledges physicians for their clinical excellence and effective utilization of health care resources. Reporting… more
- CVS Health (Baton Rouge, LA)
- …and every day. **Position Summary** The Utilization Management Manager of Prior Authorization oversees a team of clinical professionals to ensure the ... Lead, coach, and develop a multidisciplinary team responsible for utilization review, prior authorization , and case management functions. + Monitor team … more
- Centene Corporation (Austin, TX)
- …**Centene is hiring a Remote Clinical Review Nurse - Prior Authorization ** to support our **Duals team ** . The **ideal candidate** will have experience ... Elective inpatient services This role is responsible for conducting clinical reviews for prior authorization ...guidelines and criteria + Works with healthcare providers and authorization team to ensure timely review of… more
- Centene Corporation (Oklahoma City, OK)
- …to resolve cases and support member/provider needs.** **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service ... guidelines and criteria + Works with healthcare providers and authorization team to ensure timely review of...assess medical necessity of care of member + Escalates prior authorization requests to Medical Directors as… more
- Elevance Health (Seven Hills, OH)
- …industry. **Build the Possibilities. Make an Extraordinary Impact.** **Title** : Clinical Pharmacist ( Prior Authorization ) **Location(s):** + Indianapolis, ... **Be Part of an Extraordinary Team ** CarelonRx is a proud member of the...By leveraging the power of new technologies, our strong, clinical -first lens and deep pharmacy expertise, we are actively… more
- CVS Health (Phoenix, AZ)
- …and utilizes various computer resources, existing criteria, and medication guidelines to perform clinical research to support prior authorization reviews. - ... And we do it all with heart, each and every day. **Position Summary** - Processes prior authorization requests received by phone, fax, or electronically… more
- University of Southern California (Newport Beach, CA)
- The Clinical Authorization Specialist will take the lead in securing medical authorizations from third party payers (commercial and government) for outpatient ... clinical documentation for chemotherapy authorizations in Keckcare for authorization submission from Medical/Nursing Staff + Submit pre-certification/pre determination… more
- University of Utah Health (Salt Lake City, UT)
- …verification, obtaining benefit information, calculating patient estimates and obtaining prior authorization before services are rendered. This position ... individual payer requires to authorize the visit. + Secures prior authorization for high dollar services such...of work. + Ability to work independently within a team setting. + Consistently demonstrates positive attitude when interacting… more
- Omaha Children's Hospital (Omaha, NE)
- …to identify authorization trends, payer barriers, and denial patterns. + Clinical Coordination + Participate in interdisciplinary treatment team meetings to ... veterans and people with disabilities. **A Brief Overview** The Prior Authorization Therapist serves as a licensed...& Advocacy + Serve as the liaison between the clinical team , revenue cycle, and payer representatives.… more
- Fallon Health (Worcester, MA)
- **Overview** **This is 3 months temporary contract position for a Prior Authorization RN.** **About us:** Fallon Health is a company that cares. We prioritize ... information from medical care providers as needed for the clinical review process * Conducts pre- authorization and...setting required. * 2 years' experience as a Utilization Management/ Prior Authorization nurse in a managed care… more
- Texas Tech University Health Sciences Center - El Paso (El Paso, TX)
- **43332BR** **Extended Job Title:** Prior Authorization Specialist **Org Level 1:** Texas Tech Unv Hlth Sci Ctr El Paso **Position Description:** Responsible for ... OR + High school diploma or GED plus current certification as a Prior Authorization Certified Specialist (PACS), Certified Healthcare Access Associate (CHAA), or… more
- US Tech Solutions (RI)
- …by the leadership team . + Work closely with providers to process prior authorization (PA) and drug benefit exception requests for multiple clients or ... **Job Title: Prior Authorization Specialist** **Location: Fully remote**... questions, escalations and judgement calls to the pharmacist team . + The Rep I, Clinical Services… more
- University of Miami (Miami, FL)
- …effective communication regarding authorization status and determination to the clinical team and on occasion the patient. + Proactive communication ... provide communication of progress and or determination to the clinical team and or the patient. He/she...Adhere and perform timely prospective review for services requiring prior authorization as well as timely concurrent… more
- Fallon Health (Worcester, MA)
- …and inpatient, utilization management operations, including but not limited to prior authorization , concurrent review and discharge planning. + Ensures ... activities. + Recommends and implements innovative process improvements for the prior authorization and utilization management processes + Develops and… more
- US Tech Solutions (May, OK)
- …assigned by the leadership team . Work closely with providers to process prior authorization (PA) and drug benefit exception requests for multiple clients or ... phone assistance to all callers through the criteria based prior authorization process. Maintains complete, timely and... questions, escalations and judgement calls to the pharmacist team . The Rep I, Clinical Services will… more
- US Tech Solutions (May, OK)
- …other clinical colleagues, healthcare professionals and members. + Follow all prior authorization procedures to guarantee an accurate process on each ... and member services department . + Refer cases not meeting clinical criteria to the Pharmacist and MD team (s)....prior authorization . + Train and mentor… more
- UCLA Health (Los Angeles, CA)
- …high-quality, evidence-based care. This position is responsible for reviewing and evaluating clinical documentation related to prior authorization requests ... care coordination and efficient utilization of resources. Key Responsibilities: + Conducts clinical reviews of prior authorization requests to evaluate… more
- US Tech Solutions (May, OK)
- …other clinical colleagues, healthcare professionals and members. + * Follow all prior authorization procedures to guarantee an accurate process on each ... services department . + * Refer cases not meeting clinical criteria to the Pharmacist and MD team...prior authorization . + * Train and mentor...prior authorization . + * Train and mentor representatives on the… more
- Cabinet Peaks Medical Center (Libby, MT)
- Cabinet Peaks Medical Center is seeking a team -oriented Prior Authorization Specialist to work in the Business Office! Reporting to the Director of Revenue ... verify patient's insurance eligibility, benefits and requirements. Request, track and obtain prior authorization from insurance carriers within time allotted for… more
