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The Clinical Review Nurse will be responsible for reviewing and processing prior authorizations for outpatient services, procedures, referrals, and Durable Medical Equipment (DME). This role involves evaluating requests using MCG guidelines and health plan criteria while ensuring the completeness and medical necessity of medical records. The nurse will also coordinate with providers to identify missing documentation and route denials to the Medical Director as necessary.
Posted 113 days ago
Provide frontline care to homeless patients.
Manage patient panels with diverse health needs.
Posted 103 days ago
Provide comprehensive medication management for oncology patients.
Collaborate with healthcare providers to create care plans.
Posted 103 days ago
Provide medication management for oncology patients.
Collaborate with healthcare teams for patient care.
Posted 98 days ago
Manage prior authorizations for patients.
Source financial assistance for medication access.
Posted 88 days ago
Optimize prior authorization workflows.
Enhance interoperability in healthcare.
Posted 84 days ago
Conduct medical necessity reviews per guidelines.
Gather clinical records for assessments.
Posted 61 days ago
Manage patient relationships effectively.
Support patients with medication management.
Posted 54 days ago
Join our rapidly expanding healthcare organization as a Bilingual Pharmacy Liaison. In this role, you will provide essential patient support in a Spanish clinic setting, ensuring timely medication delivery and addressing insurance challenges. Collaborate with clinical pharmacists and healthcare providers to advocate for patients navigating complex therapies. With a competitive salary, generous PTO, and immediate health benefits, this opportunity offers significant career growth in a supportive environment.
Coordinate medication delivery and refills.
Posted 49 days ago
Join a dynamic team as an RCM Claims Status Manager, where you'll lead a remote group of specialists dedicated to enhancing claim resolutions and payer communications. This pivotal role involves managing electronic inquiries, documenting responses, and ensuring compliance with service level agreements. With over five years in healthcare billing operations and a strong grasp of claims workflows, you will identify trends and resolve discrepancies effectively. This is an exciting opportunity to drive improvements in revenue cycle management and contribute to the financial health of healthcare services.
Oversee electronic claim inquiries and payer communications.
Posted 41 days ago
The Patient Access Manager role offers a unique opportunity to lead the daily operations of patient access in a dynamic healthcare environment. You will be responsible for overseeing verification, authorization, and onboarding processes, ensuring financial clearance for patients. This position involves tracking performance metrics, coaching team members, and collaborating with various departments to enhance operational efficiency. With a focus on compliance and quality, this remote-friendly position is ideal for an experienced professional looking to make a significant impact in patient care.
Track SLA, quality, and productivity.
Posted 36 days ago
This role as a Clinical Pharmacy Specialist in HIV offers an exciting opportunity to make a significant impact on patient care. You will be responsible for managing medication regimens, collaborating with healthcare teams, and ensuring optimal treatment outcomes for patients with HIV. The company provides robust support including medical, dental, and vision insurance, generous PTO, and professional development opportunities. Join a dedicated team focused on quality improvement and patient-centered care in an ambulatory setting.
Collaborate with healthcare professionals under a CPA.