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Areas of oversight for this position include, but are not limited to, case management, quality management, utilization management (UM), and grievance and appeals and committee participation. The Medical Director of Behavioral Health is responsible for clinical oversight, clinical leadership, and partnership in the management of the IEHP behavioral health activities in all lines of business.
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Payer Formularies and restrictive Utilization Management Criteria including: Prior Authorization Processes, Step Edits, Appeals, detailed Clinical Documentation, Peer to Peer reviews etc.
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Field Reimbursement Manager, Immunology Position Summary: The Field Access & Reimbursement environment for specialty biologics has proven to be highly challenging for HCPs and Patients. requires dedicated and focused customer facing support through the Reimbursement Management Team. The Field Reimbursement Manager is a critical front-line member of the Regeneron Commercial and Field Reimbursement Management team.
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Overview Working in a fast-paced, high volume, dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve as a liaison and patient advocate between Dana Farber Cancer Institute and various health plans.
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The RBM position requires the ability to successfully navigate across multiple internal stakeholders, sales teams, Payer teams, Alliance partners, HUBs, etc. The Field Reimbursement Management reports to the District Manager of Field Market Access.
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Ensuring optimal access, effective pull-through, and understanding of access services and program support as it relates to the Regeneron product portfolio. Essential Duties/Responsibilities:Work cross-functionally and collaboratively with Regeneron and Alliance sales organizations (Sales Directors and Medical Specialists) to act as a process and payer subject matter expert, in efforts to support the healthcare provider segment.
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Clinical Compliance, Healthcare Administration, Healthcare Complaints/Appeals, Risk Management. Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information.
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Effectively communicate medical necessity of services, utilizing the American Society of Addiction Medicine (ASAM) guidelines for care+ Complete appeals process with third-party payers as needed.
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Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.Minimum of 10 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.
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Including but, not limited to Managed Care, Reimbursement, Clinical, Admissions, Facility Business Office Manager, Coding, Case Management, HIM and Charge Master Departments. Responsible for managing CBO Aging Report properly to insure appeals are followed up timely to prevent past filing deadlines.
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Representing more than 200 physicians, UT Physicians are leaders in clinical care, research and education of the future physicians, providing care in a wide range of medical specialties from the most complex diagnoses and treatments to primary care for the entire family.
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Proficient in drafting legal documents, including appeals, demand letters, and litigation briefs. Serves as an in-house counsel for the University of Toledo Physicians and interprets complex legal matters, mitigates risk, and ensures compliance with laws and regulations.
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As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team.
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Educate and ensure providers understand payer prior authorization requirements, appeals process, clinical criteria, and appropriate coding information. Brief Description: The EMD Access and Reimbursement Manager (ARM) is responsible for executing the Epidiolex market access business plan pertaining to the assigned geography.
$148,000 - $194,250 a yearFull-timeRemoteExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Our team consists of 5 board certified Child and Adolescent Psychiatrists, 4 APRNS, 15 Clinical Psychologists, a Neuropsychologist, 6 Licensed Mental Health Providers, and 4 Clinic RNs. The Psychologist will deliver care through face to face and telehealth methods.
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