- AmeriHealth Caritas (Newtown Square, PA)
- …Utilization Management staff. Oversee staff performance with regard to prior authorization , medical necessity determinations, concurrent review, retrospective ... work closely with the Directors of Pharmacy, pharmacy benefits manager (PBM), and the State's PBM team. + Prepare...+ 3+ years of experience performing utilization management reviews ( prior authorization and concurrent review) as a… more
- Humana (Hartford, CT)
- …ICD-10 codes. + Member service + Experience with Utilization Review and/or Prior Authorization , preferably within a managed care organization. **Additional ... caring community and help us put health first** The UM Administration Coordinator 2 provides non-clinical support for the...in special projects as assigned by your Supervisor or Manager . **Use your skills to make an impact** **Required… more
- Fallon Health (Worcester, MA)
- **Overview** **The UM Inpatient Service Coordinator is a telphonic role working with hospital offices regarding inpatient or hospital stays prior authorizations ... and members to collect pertinent Acute Inpatient, Maternity and Post-Acute authorization request data and disseminates information to the Utilization Nurses for… more
- LA Care Health Plan (Los Angeles, CA)
- …Preferred: Experience in Medi-Cal managed care. 1 year of experience in UM / Prior Authorization . Skills Required: Demonstrated proficiency in Medical ... support the safety net required to achieve that purpose. Job Summary The Authorization Technician II supports the Utilization Management ( UM ) Specialist by… more
- Ventura County (Ventura, CA)
- …cases, facilitates timely discharges/transfer to network facilities, and completes the UM authorization process in accordance with standard timelines and ... Manager - Patient Services - Ventura County Health...years of service or other public service. *Credit for prior public service may be considered (Management Resolution, |… more
- Whidbey General Hospital (Coupeville, WA)
- JOB SUMMARY The RN - Care Manager is a health care professional with experience and background to assure compliance with CMS Conditions of Participation regarding ... Utilization Review and Discharge Planning. The RN - Care Manager will lead an assessment to identify the patient's...accordance with WhidbeyHealth policies, as well as monitors for authorization by the physician. + Complies with all documentation… more
- Covenant Health Inc. (Louisville, TN)
- …Provides daily appropriate direction to all departments on issues pertaining to prior authorization , concurrent and retrospective review. + Confers with ... serves. Position Summary: Reviews information with payors to obtain authorization for payments. Recruiter:Sandra Simmons ||###@covhlth.com|| ### Responsibilities +… more
- VNS Health (Manhattan, NY)
- …appropriateness of admissions, treatment, level of care and lengths of stay. Performs prior authorization and concurrent reviews to ensure extended treatment is ... cost-effective health care services. Manages providers, members, team, or care manager generated requests for medical services and renders clinical determinations in… more
- Sanofi Group (Dallas, TX)
- …create process delays for patients like required Benefits Investigations (BI), Prior Authorization (PA), Denial Appeals, detailed Clinical Documentation, and ... **Job Title:** Transplant Field Reimbursement Manager , South Central - US **Location:** Dallas, TX...include payer specific requirements for claims processing, information regarding prior authorizations and the appeals process, as well as… more
- Stanford Health Care (Palo Alto, CA)
- …to ICD-10, CPT, HCPCS, ASA + Knowledge of medical management statistics relating to UM /CM and prior authorization process management. + Extensive knowledge ... State Licensure And/Or Compact State Licensure . + CCM - Certified Case Manager preferred . **These principles apply to ALL employees:** **SHC Commitment to… more