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Temporary/Relief Primary Care Physician shall agree that, as required by law, excluding emergency and primary care services, prior authorization must be obtained in writing from the respective CDCR/CCHCS Institution/Facility CEO/CME or designee, in accordance with CCHCS's Utilization Management Plan. Temporary/Relief Primary Care Physician shall complete and return all forms required by CDCR regarding treatment of patient/youth.
Full-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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This includes Prior Authorization / Pre Certification / Concurrent Reviews / Peer to Peer Calls / First Level Appeals / Special Projects and Committee participation when needed. You will participate in the development, implementation, and evaluation of clinical / medical programs and expand Aetna's medical management programs to address member needs across the continuum of care.
$169,000 - $364,000 a yearFull-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Offer office education during the entire access process which may include formulary coverage/utilization management criteria, insurance forms & procedures, benefits investigation, prior authorization, appeal, and/or claims resolution.
$112,000 - $118,000 a yearFull-timeExpandApply NowActive JobUpdated 16 days ago - UpvoteDownvoteShare Job
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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.
ExpandApply NowActive JobUpdated 9 days ago - UpvoteDownvoteShare Job
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Manages current clients in all Medical Pharmacy programs such as Fee Schedule Management, Prior Authorization, Post Service Claim Edits, Site of Service and any additional programs.
RemoteExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Knowledge of legislative/oversight bodies (e.g., URAC-Utilization Review Accreditation Commission, CMS-Centers for Medicare & Medicaid Services, NCQNational Committee for Quality Assurance, and ERISEmployee Retirement Income Security Act of 1974.
RemoteExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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Relevant specific practice management experience. In this role, be responsible for the management of defined accounts in a specified geographic region in the bone health therapeutic area, specifically supporting our client's products.
ExpandApply NowActive JobUpdated 9 days ago - UpvoteDownvoteShare Job
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Provide coverage recommendations for medications subject to prior authorization, appeals, retrospective claim reviews, and audits based on applicable medication coverage policies, member benefit contracts, and provider contracts.
$112,000 - $184,000 a yearFull-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Support patient access assistance from prescriber decision through to fulfillment, supporting the entire Reimbursement journey through payer prior authorization to appeals/denials requirements procedures and forms.
ExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Performs prior authorization, precertification, and retrospective reviews and prepares decision letters as needed in support of the utilization review contract Assists management with training new Nurse Reviewers to include daily monitoring, mentoring, feedback and education.
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Education : Master's degree in social work, mental health, or a related field or RN with prior Utilization Management and Behavioral Health experience. Utilization Management Coordinator will also review with payor sources and receive authorization for the type and volume of services through all levels of care and aftercare review.
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Evaluates medication utilization and prior authorization requests for medications available via the pharmacy benefit and the medical benefit including specialty ambulatory injectable and/or infusion medications as related to member benefits, medical necessity, site of service, and evidence based clinical guidelines.
Full-timeExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
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Must have general payer policy knowledge including public & private payers, foundational knowledge of benefit verifications & prior authorization/pre-determination requirements (including appeals/exceptions), & knowledge of access & reimbursement processes within various sites of care.
ExpandApply NowActive JobUpdated 9 days ago - UpvoteDownvoteShare Job
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Follows policies and procedures for all Utilization Management (UM), discharges, Standardized Outcome Measures, Durable Medical Equipment (DME) forms and patient status reports. Meets all regulatory requirements for payment (ex: Pre-authorization, POCs, UM, etc.
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Completes daily formulary operational processes, including tracking, processing, and obtaining appropriate documentation for pharmacy medical exception requests, prior authorization requests, reconsiderations, and appeals.
Full-timeExpandApply NowActive JobUpdated 2 days ago
utilization management prior authorization jobs
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