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The UM Prior Authorization Nurse confers with Nursing Manager, VP of Clinical Policy and/or Medical Director whenever appropriate in utilization management or problem solving. The UM Prior Authorization Nurse is primarily responsible for reviewing referrals for medical.
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Clarest Health is looking to hire a LTC Prior Authorization Pharmacist to work in our brand-new, state-of-the-art Clinical Hub located in Phoenix, Arizona. Review prior authorization paperwork for accuracy and completeness.
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The Prior Authorization Specialist is responsible for obtaining appropriate insurance verification, prior approval and all authorization requirements prior to a patient's arrival for a procedure.
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Our full-time Prior Authorization Nurse Analyst is a work from home position that will assist in reviewing medical documentation for prior authorization requests submitted.
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Join Networks Connect LLC, a leading staffing agency, as we seek a skilled Prior Authorization Specialist for an exciting opportunity in the healthcare sector in the Silver Spring, MD area.
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Under direction from the Supervisor, Specialty Pharmacy Services, and pharmacists in the Specialty Pharmacy, the Prior Authorization Specialist I is primarily responsible for obtaining information and assisting providers and insurance companies in triaging prior authorizations for patients of the specialty pharmacy.
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POSITION SUMMARY: Obtains pre-certification for all inpatient admission and pre-authorization for all outpatient diagnostic tests and performs an administrative support function. Demonstrates skill in the proficient use of PC and UVA software systems to ensure that all pre-certification/pre-authorization information is entered into required computer systems in an accurate and timely manner.
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We are proud of the recognition we have received from local and national organization regarding our culture and workplace:Role SnapshotOur full-time Prior Authorization Nurse Analyst is a work from home position that will assist in reviewing medical documentation for prior authorization requests submitted.
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For patients who do not receive insurance coverage, the prior authorization specialist refers accounts to the financial counselor and/or identifies the patients who need to receive a Medicare Advance beneficiary Notice of Noncoverage (ABN.
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Provide written explanations for non-affirming prior authorization requests. Preferred QualificationsPrior authorization, utilization management, or medical/chart review experienceBachelor's degree in Nursing4 or more years of experience in clinical nursingUnderstanding of Medicare government insurance.
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Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare and its members. + Refers appropriate prior authorization requests to Medical Directors.
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The Prior Authorization Coordinator is responsible for striving to complete either approval for pharmacy claims requiring prior authorization or by coordinating with prescribers and or facility contact to have therapy changed to a preferred alternative due to insurance not covering the treatment in question.
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Collaborating with a team of both clinicians and non-cliniciansDeepening your understanding of Medicare and how the program worksLearning about our Hyland OnBase tool which is our content management system used for viewing electronic recordsExperience working in an environment that serves our Nation's military, veterans, Guard and Reserves and Medicare beneficiariesContinuous performance feedback.
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Who We Areis a leading not-for-profit health insurer and federal government contractor headquartered in Wisconsin. Remote Work RequirementsWired (ethernet cable) internet connection from your router to your computerHigh speed cable or fiber internetMinimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at )Please review for additional information.
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If you are qualified and interested in the Prior Authorization Specialist role, please apply today! Gather additional clinical and or coding information, as necessary, in order to obtain prior authorization.
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Title: prior authorization Company: Health Choice
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