- Select Medical (Lakeway, TX)
- …A joint venture with Select Medical & Baylor Scott & White Health ** Prior Authorization Specialist -** **onsite only** **This position must work** **onsite** ... and independent judgment, the Payor Relations Specialist manages the pre-certification and prior authorization of referrals scheduled for admission to the Acute… more
- Centene Corporation (Austin, TX)
- …services to ensure level of care and services are medically appropriate + Performs prior authorization reviews related to mental health and substance abuse to ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Sutherland Global Services (Austin, TX)
- …Requests + Authorizations + Status Inquiries + Denial Rationale + Utilization Management Appeals + Prior Authorization Verification + Eligibility and ... attitude + Multi-tasking skills with a strong attention to detail + Time Management skills + Sufficient Internet speeds while connected to a Remote Desktop Session… more
- CVS Health (Austin, TX)
- …support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities ( prior authorization and appeals) and responds to ... Clients as assigned. The Medical Director transacts Utilization Management UM activities ( prior authorization and appeals) and responds to prescriber… more
- Humana (Austin, TX)
- …with prior experience participating in teams focusing on quality management , utilization management , and acute inpatient rehabilitation **Preferred ... of care, and/or requested site of service should meet authorization requirements. All work occurs within a context of...Integrated Delivery Systems, health insurance, other healthcare providers + Utilization management experience in a medical … more
- Molina Healthcare (Austin, TX)
- …(RN) Registered Nurse with previous experience in Hospital Acute Care, Concurrent Review/ Utilization Review / Utilization Management and knowledge of ... financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. + Processes… more
- Prime Therapeutics (Austin, TX)
- …information into the appropriate delivery system to initiate the EAP, Care and Utilization management programs. + Demonstrates flexibility in areas such as job ... include answering incoming calls related to eligibility, benefits, claims and authorization of services from members or providers. Responsibilities also include the… more
- Humana (Austin, TX)
- …and/or experience with medical terminology and/or ICD-10 codes + Experience with Utilization Review and/or Prior Authorization , preferably within a ... health first** The UM Administration Coordinator 2 contributes to administration of utilization management . The UM Administration Coordinator 2 performs varied… more
- Prime Therapeutics (Austin, TX)
- …+ Manages current clients in all Medical Pharmacy programs such as Fee Schedule Management , Prior Authorization , Post Service Claim Edits, Site of Service ... client presentations + Leads evaluation and identification opportunities for improved management of Medical benefit drugs through clinical research and analytics… more
- The Cigna Group (Austin, TX)
- …in core actuarial areas such as pricing, reserving, forecasting, and risk management . Additionally, you may also explore opportunities in areas such as data ... science, analytics, investment management , operations, and underwriting. A typical experience consists of...economics department, where you would analyze pharmacy costs and utilization metrics to drive savings for our clients and… more