Manager Prior Authorization Jobs in Raleigh, NC (NOW HIRING)

Remote Prior Authorization Pharmacist - Work From Home in Managed Care A confidential managed care organization is seeking a motivated Remote Prior Authorization Pharmacist to evaluate prescription ...

... management system.. Key Responsibilities * Obtain prior authorizations and pre-certifications for medications, procedures, and specialty services * Verify insurance benefits and identify ...

In-office days follow a rotating schedule model determined by management. Key Responsibilities ... At least 2 years of experience in medical insurance, billing, or prior authorizations strongly ...

In-office days follow a rotating schedule model determined by management. Key Responsibilities ... At least 2 years of experience in medical insurance, billing, or prior authorizations strongly ...

You will handle inbound calls, troubleshoot claim rejections, manage prior authorization workflows, and ensure precise documentation so patients receive timely and safe access to their medications.

You will handle inbound calls, troubleshoot claim rejections, manage prior authorization workflows, and ensure precise documentation so patients receive timely and safe access to their medications.

Build Medical / Care Management platform, providing market-leading solution for Utilization Mgmt., Prior Authorization, Case & Disease Management and Concurrent Review. Top Requirements: * Cypress

Understanding of reimbursement processes including prior authorization, appeals, and denied claims management * Knowledge of HIPAA guidelines and FDA regulatory requirements * Familiarity with ...

Workqueue (WQ) Management * Build and maintain workqueues for scheduling, referrals, and prior authorizations. * Configure routing rules, triggers, and prioritization logic to ensure efficient task ...

Workqueue (WQ) Management * Build and maintain workqueues for scheduling, referrals, and prior authorizations. * Configure routing rules, triggers, and prioritization logic to ensure efficient task ...

Communicate the need for medication prior authorization (PA) to providers and serve as a resource to the provider during the PA process. * Manage inbound calls from patients, clients, physicians ...

Communicate the need for medication prior authorization (PA) to providers and serve as a resource to the provider during the PA process. * Manage inbound calls from patients, clients, physicians ...

Communicate the need for medication prior authorization (PA) to providers and serve as a resource to the provider during the PA process. * Manage inbound calls from patients, clients, physicians ...

... prior authorization to claims integrity and care management. Retrieval, grounding & context engineering Develop end-to-end Retrieval-Augmented Generation (RAG) pipelines: ingestion, chunking ...

Pharmacist license in state of residence, active and in good standing Prior authorization experience in PBM or managed care environment Experience in PBM, Managed Care, or VA Veterans Hospital

The Afterhours Utilization Management Representative III is responsible for coordinating cases for precertification and prior authorization review. How you will make an impact: * Responsible for ...

The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review. Hours : Training is conducted from 7:00 AM to 3:30 PM Mountain ...

The Utilization Management Representative I is responsible for coordinating cases for precertification and prior authorization review. Hours : Training is conducted from 7:00 AM to 3:30 PM Mountain ...

The Afterhours Utilization Management Representative III is responsible for coordinating cases for precertification and prior authorization review. How you will make an impact: * Responsible for ...

At least a year of experience in a related role (utilization review, case management, care coordination, insurance authorization/prior authorization, clinical documentation review, hospital patient ...