- University of Miami (Miami, FL)
- …CORE FUNCTIONS: + Adhere and perform timely prospective review for services requiring prior authorization as well as timely concurrent review for continuation of ... conducts initial, concurrent and retrospective chart reviews for clinical utilization and authorization . The Utilization Review Case Manager coordinates with the… more
- Hackensack Meridian Health (Hackensack, NJ)
- …/Radiation Oncology services in the HMH Health care system. This pertains to Prior Authorization for Oncology services, as well as various specialized ... clinical data is submitted to substantiate the request for prior approvals for oncology services. **Responsibilities** A...in order to avoid technical denials for lack of prior authorization . Understand if payer rules governing… more
- University of Virginia (Charlottesville, VA)
- Provide billing and compliance support within the Division of Radiation Oncology to include; compliance and charge capture, referral/medical necessity, denial ... support to clinic and administrative personnel within the Division of Radiation Oncology . + Assures that all referrals are managed effectively and efficiently for… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …provides Utilization Management services to its clients. The Utilization Management Nurse - Prior Authorization performs medical necessity reviews on prior ... to ensure timely review of services and care. * Provides referrals to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed. *… more
- University of Virginia (Charlottesville, VA)
- …Required tasks and database information, not completed during intake, are accurately completed prior to forwarding case . d. Exhibits a thorough working knowledge ... in the proper Epic system such as OpTime, Cupid, or Radiant. a. Scrubs case order for accuracy and completeness. Ensures diagnoses and procedure match. Review all… more
- MD Anderson Cancer Center (Houston, TX)
- …to comply with institutional standards, initiatives, and guidelines (ABN's, prior authorization requirements, reimbursement optimization, formulary management, ... learning experiences. * Effectively precepts other trainee-required experiences including oncology forum, research projects, grand rounds, MUEs, etc. * Collaborates… more
- Trinity Health (Boise, ID)
- …Clinical Research Coordinator to join our team in Boise in support of Oncology research! **POSITION PURPOSE:** As a Clinical Research Coordinator, you will work ... review of protocol eligibility requirements and confirms patient eligibility. + Performs case management of study participants. + Submits required data to research… more
- Hackensack Meridian Health (Hackensack, NJ)
- …of studies for feasibility and evaluates potential competition with other protocols prior to submitting study + Reviews study with principal investigator and/or ... consent + Educates study patients concerning informed consent procedures, HIPAA authorization + Documents study patient?s medical history including but not limited… more
- Beth Israel Lahey Health (Boston, MA)
- …for patients from referral/consultation to discharge /follow up. Assists with pre- authorization process. 2. Serves as contact and facilitator to receive consults ... of patient/family educational materials. Participates in patient rounds and case conferences. 5. Updates clinical knowledge and skills through consultation,… more
- Blue KC (Workman, MN)
- …available resources to promote optimal, cost-effective outcomes. Transplant only: Provides prior authorization for, coordinates, and individually manages all ... work appropriately. Additional duties for Transplant only: + Provides prior authorization of the transplant and manages...medical policy. Opens case and follows NCQA case management standards. Documents transplant authorization , issues… more
- University of Washington (Seattle, WA)
- …to complete it within 30 days of hire. **DESIRED QUALIFICATIONS** + Knowledge of oncology practice and terminology. + Prior working experience at the UWMC, FHCC, ... Req #: 234315 Department: DEPARTMENT OF MEDICINE: HEMATOLOGY AND ONCOLOGY Posting Date: 05/17/2024 Closing Info: Open Until Filled Salary: $4,583 - $5,230 per month… more
- Tidelands Health (Pawleys Island, SC)
- …responsible for accurate and complete insurance verification, financial clearance and prior authorization , and complete pre-registration of all scheduled ... Five (5) year of experience in Healthcare Revenue Cycle that includes prior authorization . **KNOWLEDGE/SKILLS/ABILITIES** : * Ability to interact successfully… more
- Gilead Sciences, Inc. (Ventura, CA)
- …problem solving and execution. + Launch experience within academic hospitals preferred. + Prior experience in a hematology or oncology specialist therapy area is ... and work with the ATC Onboarding Director for site authorization . **Patient Access and Reimbursement Support:** + Identifies and...+ Provides support as needed to the Kite Konnect Case Managers who will lead individual patient case… more
- Northern Light Health (Portland, ME)
- …Office Patient Service representatives to verify benefits and to obtain required prior authorization (s). + Identify potential barriers to care and collaborates ... referrals from patients, families, and referral sources for all newly diagnosed oncology , benign hematology and infusion therapy patients seeking to come to the… more
- Providence (Vancouver, WA)
- …of Outpatient Care) + Utilization Management Experience (EX. Concurrent Review, Prior Authorization , Medical Audits, Appeals or Delegation) + Experience ... a Clinical Program Coordinator RN who will:** + Provide care coordination, case management and care management services to Providence Health Plans(PHP) members +… more
- Pfizer (Collegeville, PA)
- …within IM (Internal Medicine); in addition to other businesses as required (RD, Oncology , I&I). This role is responsible for supporting patient access and support ... within the Pfizer 'Hybrid Hub' model, third party hub vendors, internal case management teams, and patient support roles (FAL/FRM/FAS/PAC/PAN/AN), and/or new patient… more
- LifePoint Health (Martinsville, VA)
- …number(s).. . Contacts physician's office, when necessary, to resolve any issues regarding prior authorization or referral forms. . Communicates all exam prep ... a variety of the Hospital's patient information related systems, assesses each case related concern and resolves issues with regards to appointments, financial… more
- Elevance Health (Chicago, IL)
- …guidelines into system useable algorithms that support Carelon's automated, portal based prior authorization capability. In partnership with the Solution Medical ... savings across an expanding set of clinical domains, including Radiology, Cardiology, Oncology , HH and DME. Responsible for serving as the chief medical officer… more
- Hartford HealthCare (Bridgeport, CT)
- …communication as required, to Agency personnel and other reimbursement sources. * Obtains prior authorization for services when indicated by calling payers and ... and schools and colleges. We offer a variety of specialists, including oncology , women's health, sports medicine, physical therapy, occupational therapy and speech… more
- Option Care Health (Indianapolis, IN)
- …Care and externally with customers (ex. medical director, head of case management, executive c-suite individuals). **Travel Requirements** **: (if** **required)** + ... at least 4 years of pharmaceutical or healthcare sales experience. + Prior experience selling strategic solutions (specialty products and/or services) to hospitals,… more