- CVS Health (Austin, TX)
- …to work in a fast paced environment Preferred Qualifications + Previous prior authorization experience Education Associates degree required BSN preferred Pay ... Range The typical pay range for this role is: $29.10 - $62.31 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a… more
- CVS Health (Austin, TX)
- …up to 8:00pm EST zone (twice per month) Preferred Qualifications + Prior Authorization or Utilization Management experience + Managed care experience + ... are Monday-Friday 9a-6p in time zone of residence. Position Summary Precertification: Utilization Management Nurse Consultant + Utilizes clinical experience and… more
- Centene Corporation (Austin, TX)
- …to mental health and substance abuse + Performs and manages the most complex prior authorization reviews related to mental health and substance abuse to ... around mental health and substance abuse for complex members based on prior experience and recommends improvements related to utilization review processes… 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
- Evolent Health (Austin, TX)
- …or Chiro, Pharmacist - **Required** + Working knowledge of utilization management activities such as prior authorization , concurrent review, intake, ... culture. **What You'll Be Doing:** **Value Proposition Statement:** As a Director, Utilization Management , you'll work with your managers, front line clinical… more
- Highmark Health (Austin, TX)
- …the Organization's management programs including but not limited to: prior authorization , dose and duration edits, quantity limits, step-care edits, ... in the development and implementation of utilization management programs including but not limited to: prior... management programs including but not limited to: prior authorization , dose and duration edits, quantity… more
- Humana (Austin, TX)
- …integrated care needs for those with autism + Prior experience with Utilization Review, Utilization Management , Peer Reviews and/or Quality Management ... us put health first** This is a non-exempt position with responsibility for utilization management and clinical decision-making as outlined in the Autism Care… more
- American Express Global Business Travel (Austin, TX)
- …Perform other duties as required. **Roles & Responsibilities:** **PROCESS MANAGEMENT :** + Review meeting request and conducts meeting qualification call ... team members and suppliers of program status. + Review all supplier contracts prior to finalization, ensure both program specific and generic terms and conditions… 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
- CVS Health (Austin, TX)
- …Analyst will also assist with providing strategic direction to the Novologix Prior Authorization Operations leadership teams within the Clinical Services ... projects independently Required Qualifications - 2 years experience in pharmacy, pharmacy management , formulary management , drug utilization , managed care… more
- CVS Health (Austin, TX)
- …responsible for predetermination reviews and reviews of claim determinations. This includes Prior Authorization / Pre Certification / Concurrent Reviews / Peer ... of clinical / medical programs and expand Aetna's medical management programs to address member needs across the continuum...the continuum of care. You will support the Medical Management staff ensuring timely and consistent responses to members… 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