- CVS Health (Baton Rouge, LA)
- …and enrollees on prior authorization requests for services. The UM Coordinator will collaborate with all key stakeholders ensuring enrollees access and ... days of the scheduled appointment * Assists with problems on each prior authorization requests, including identification of new providers, notification to… more
- Humana (St. Paul, MN)
- …service telephone experience desired + Experience with Utilization Review and/or Prior Authorization , preferably within a managed care organization ... caring community and help us put health first** The UM Administration Coordinator 2 contributes to administration...Proficient utilizing electronic medical record and documentation programs + Prior experience with CGX and Genesys + Prior… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role The UM Coordinator is responsible for coordinating all aspects of the prior authorization process, including member eligibility and ... members of the organization. Primary Responsibilities + Research and confirm authorization requirements and communicate to member, providers, and facility staff. +… more
- Centers Plan for Healthy Living (Margate, FL)
- …authorization requests for eligible members. PRIMARY RESPONSIBILITIES: + Assists in the prior authorization of services and ongoing authorization requests ... plans they need for healthy living. JOB SUMMARY: The Utilization Management Care Coordinator works within a multidisciplinary care team to assist with the care of… more
- Integra Partners (Troy, MI)
- The UM Coordinator assists and supports the clinical team ( UM Nurses/Medical Director) with administrative and non-clinical tasks related to processing ... Utilization Management prior authorization sand appeals. JOB RESPONSIBILITIES +...Maintaining expected timelines EXPERIENCE: + 1 year as a UM Coordinator in a managed care payer… more
- Fallon Health (Worcester, MA)
- …of purpose** : Under the direction of the Manager of Prior Authorization , communicates with contracted and non-contracted facilities/agencies/providers to ... collect pertinent prior authorization request data and disseminates information...incoming calls from the multiple ACD lines for the UM department addressing and/or referring customer (provider/member) calls/inquiries, provide… more
- Blue KC (Workman, MN)
- …available resources to promote optimal, cost-effective outcomes. Transplant only: Provides prior authorization for, coordinates, and individually manages all ... Prioritizes work appropriately. Additional duties for Transplant only: + Provides prior authorization of the transplant and manages individual member… more
- University of Southern California (Alhambra, CA)
- …patients to validate that the appropriate patient status is assigned upon admission and prior to discharge; InterQual or MCG reviews are completed within 24 hours of ... utilizing data from multiple sources, as supported by the ambulatory care coordinator . 4. Analyze and interpret data in collaboration with patient, family,… more
- Adecco US, Inc. (Minneapolis, MN)
- …authorizations submitted by providers within the designated turnaround times specified in the Prior Authorization List for all lines of business, including RMHP ... RMHP CHP+, RMHP IFP, and NHP RAE Medicaid + When processing authorization requests, the Clinical Coordinator applies approved medical necessity criteria… more
- Highmark Health (Pittsburgh, PA)
- …administration of effective and efficient processing for pharmacy benefits prior authorization processes, insurance evaluations, addressing patient medication ... medication reconciliation, and overseeing referral screening/management. **ESSENTIAL RESPONSIBILITIES** + Prior Authorization & Utilization Management: Reviews pharmacy… more