- Actalent (Oklahoma City, OK)
- Actalent is currently hiring for a Remote Prior Authorization Pharmacist! *Oklahoma RPh License Required* Job Description: + Completes assigned daily cases ... by processing prior authorization and medical necessity requests. + Review specialty medication prior authorization requests. + Conduct comprehensive… more
- TEKsystems (Rochester, NY)
- …across all lines of business including Medicare D to determine what type of prior authorization review is required, documents any relevant medication history ... permitted by law including the initial level processing and review of prior authorization requests...M-F 8am-5pm EST (no part time hours being offered) Remote but you must live in one of their… 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
- Kepro (AL)
- …+ Prior experience or knowledge of durable medical equipment prior authorization requirement. + + Excellent written and verbal communication ... for health solutions in the public sector. Acentra is seeking a Physical Therapist Reviewer PRN to join our growing team. **MUST RESIDE IN THE STATE OF ALABAMA**… more
- Kepro (Harrisburg, PA)
- …post-acute or rehabilitation environment required + Minimum of one year UR and/or Prior Authorization or related experience + Must be proficient in computer ... vital partner for health solutions in the public sector. Acentra seeks a Clinical Reviewer to join our growing team. Job Summary: Utilizes clinical expertise for the… more
- Kepro (Harrisburg, PA)
- …post-acute or rehabilitation environment required + Minimum of one year UR and/or Prior Authorization or related experience + Must be proficient in computer ... vital partner for health solutions in the public sector. Acentra seeks a Clinical Reviewer to join our growing team. Job Summary: Utilizes clinical expertise for the… more
- Medical Mutual of Ohio (OH)
- …of medical/pharmacy terminology/coding and managed care processes. Understanding of the medical review (ie, prior authorization ) process and managed care ... **_Note,_** **_this is a fully remote opportunity in Ohio_** . Founded in 1934,...of services and procedures. Manages initial, concurrent, and retrospective review of cases, including appeals, through evaluation of clinical… more
- Centene Corporation (Tallahassee, FL)
- …flexibility. **Must be a current Florida resident!!** **Centene is currently seeking a Clinical Review Nurse - Prior Authorization to join our team. This ... Time Zone With flexibility to work overtime. **Position Purpose:** Analyzes all prior authorization requests to determine medical necessity of service and… more
- Fairview Health Services (St. Paul, MN)
- …computer systems, including Microsoft Office 365 **Preferred** **Experience** + Referrals and/or prior authorization experience + Epic experience + Knowledge of ... **Overview** _Overview_ This is a remote position under Revenue Cycle Management that is responsible for obtaining all medical necessity approvals for a patient's… more
- Spectrum Billing Solutions (Skokie, IL)
- …is managed in the most efficient and streamlined manner. We are seeking to add an ABA Prior Authorization / UR Specialist to our growing team. The ABA Prior ... hybrid remote /in-office, or to work 100% fully remote . Your Responsibilities: + Review patient...information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization… more
- Sutter Health (Sacramento, 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
- Molina Healthcare (UT)
- …benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina ... its members. + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional… 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 ... data entry, data management, and reporting. **Experience:** + * Review criteria-based prior authorizations following policy and... prior authorization . + * Train and mentor… more
- Molina Healthcare (Seattle, WA)
- …WA state LPN licensure. Candidates with p** **revious Utilization Management and Prior Authorization experience are highly preferred** **.** **_Further details ... benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina… more
- Molina Healthcare (CA)
- …code knowledge** **CPT code knowledge** **IPA or health plan UM experience( Prior authorization or Inpatient)** **Job Qualifications** **Required Education** HS ... + Provides telephone, clerical, and data entry support for the Care Review team. + Provides computer entries of authorization request/provider inquiries,… more
- St. Luke's University Health Network (Allentown, PA)
- …patient class obtained prior to discharge, communicate back to PEC for re- authorization , as needed + Is a resource to the Coding department, SLPG practices, ... patient's ability to pay for health care. The Surgical Review Specialist prospectively reviews, validates, and audits procedure code...patient class is obtained for IP only Medicare cases prior to date of service + Ensure all IP… more
- Actalent (Atlanta, GA)
- Actalent is currently hiring for Remote Utilization Review RNs! Job Description: + Reviewing authorization requests + Utilizing evidence-based criteria and ... request additional details if applicable. Qualifications: + Active RN License + Prior Utilization management/Concurrent review experience + Experience with MCG… more
- The Cigna Group (Seattle, WA)
- …auditors to determine validity of identified discrepancies. Analysis includes, pricing, prior authorization , eligibility, plan set-up, financial and performance ... acumen to develop models and procedures, and monitor trends, within Quality Review and Audit. Using independent judgement and discretion, may recommend changes in… more
- Molina Healthcare (Bothell, WA)
- …financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. + Processes ... to 5:00pm PST. Must be able to work PST hours.** ** Remote position preferrable in Washington State** **KNOWLEDGE/SKILLS/ABILITIES** + Assesses inpatient services… more
- University of Miami (Medley, FL)
- …a timely manner in support of patient satisfaction and allow for referral and authorization activities prior to the patient's date of service + Verification of ... faculty or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The University of… more