Average salary: $37,629 /yearly
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- ...determine options for appropriate level of care. The Behavioral Health Social Worker will have working knowledge of insurance prior authorization, medical necessity criteria and ASAM criteria. The Behavioral Health Social Worker will have the ability to handle crisis...Suggested
CharterCARE Health of Rhode Island, Inc
Providence, RI3 days ago $40k - $52.3k
...for chart reviews for the nursing team You will build and pend authorizations for review You will perform inbound and outbound calls to... ...years' experience working in an administrative support capacity Prior professional experience of Microsoft Word, Outlook and Excel with...SuggestedBi-weekly payFull timeTemporary workApprenticeshipRemote workHome officeHumana
Providence, RI4 days ago- ...Competitive Compensation (Base Salary + Percentage of collections) Support Staff: 2+ MAs trained to scribe, run prior authorizations, provide patient follow up. Well-appointed facilities complete with specialized equipment and procedure rooms Strong patient...SuggestedLocal areaImmediate start
PhyNet Dermatology LLC
Providence, RI21 hours ago - ...submits bills in a timely manner, confirms eligibility, and obtains authorization in accordance with requirement of third-party payers. Conducts... ...utilizing electronic access when available. Understands prior approval and all authorization requirements and timeframes. Investigates...SuggestedWork at officeImmediate start
$117.6k - $161.7k
A healthcare service provider in Providence, RI seeks an Informatics Lead responsible for Medicaid Prior Authorization analytics. This role involves providing advanced analytical support, collaborating with various teams, and ensuring compliance within Medicaid frameworks...SuggestedRemote jobWork at office- A healthcare organization in Warwick, Rhode Island, seeks a Financial Clearance Specialist to manage authorization processes for surgical procedures and patient admissions. You will play a vital role in evaluating payer policies and ensuring compliance with regulations...Suggested
- ...within 72 hours of receipt). Work and school notes. Use of Centricity, and Exscribe EMR to support patient care. Obtain prior authorizations for any assigned advanced imaging studies, specialty injections, prescriptions and accurately update order statuses. Monitor...SuggestedWork at officeLocal area
- ...answering inbound phone calls, processing cases and electronic authorizations, loading authorizations, and making follow-up phone calls... ...management, and reporting. Experience: · Review criteria-based prior authorizations following policy and procedure. · Provide on-...SuggestedContract workRemote workWork from homeShift work
US Tech Solutions
Providence, RI4 days ago $18 - $19 per hour
...hour Remote, RI Contract Job Description: The Tech I Prior Auth takes in-bound calls from providers, pharmacies, members,... ...assistance to all callers through the criteria based prior authorization process. Maintains complete, timely and accurate documentation...SuggestedHourly payContract workRemote workUS Tech Solutions
Providence, RI1 day ago$15.9 - $17 per hour
...the much‑needed care as soon as possible. Requests health plan authorizations/information as required; either electronically or verbally.... ...equipment outside of the United States is not permitted without prior authorization. Teammate Benefits As an Accendra Health...SuggestedHourly payTemporary workWork at officeLocal areaImmediate startRemote workHome officeFlexible hours$115.2k - $158.4k
...Research, understand and apply laws, regulations, and regulatory guidance for HCS operations, including, but not limited to prior authorizations, quality of care, and clinical programs for the Part C Medicare line of business. Serve as the subject matter expert on HCS...SuggestedFull timeContract workTemporary workRemote workHumana
Providence, RI4 days ago- ...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 requests, ensure medical necessity, and improve patient access to safe...SuggestedRemote jobWork from homeFlexible hours
- ...Job Position This position is responsible for reviewing and completing criteria based on prior authorization as per policy and procedure. Responsibilities: ~ Reviewing and completing criteria based on prior authorization as per policy and procedure. Experience...Suggested
- ...and courteous manner Answer phones and manage appointment scheduling Verify insurance and process referrals Handle prior authorizations for procedures (MRI, CT scans, etc.) Assist with TDI/FMLA paperwork and documentation Maintain accurate patient records...SuggestedPart timeWork at officeMonday to FridayFlexible hours
HW Staffing Solutions - Cumberland RI
Middletown, RI6 days ago $50.52k - $83.35k
...during the referral process. Contacts third party review agencies as necessary to obtain patient-specific information and prior authorization to appropriately advocate for the patient. Updates the patient pharmacy informationfor the patients discharging to SNF Completes...SuggestedWork at officeShift workBrown University Health
Providence, RI1 day ago$27 per hour
...2 Months) Pay Rate USD 27 hourly The Licensed Practical Nurse (LPN) will provide processing and communication of Commercial Prior Authorizations (PA) reviewed by the Commercial PA team for Pharmacy benefits. Reporting to the Pharmacy Operations Manager, working with physician...Hourly payContract workWork experience placementRemote workShift workSonya M. Recruiting
Providence, RI4 days ago$118k - $206.25k
...Clinical Development Pharmacist will develop clinically and ethically based content for drug coverage programs in support of prior authorization, step therapy, quantity and formulary review programs for CVS Health. The UM pharmacist will participate in the interpretation...Hourly payFull timeTemporary workWork at officeLocal areaWork from homeFlexible hours- ...prescribed by the team physician/psychiatrist; evaluate and chart medication effectiveness, complications, and side effects. Complete Prior Authorization procedures based on patient’s insurance requirements as needed. Develop and maintain disease or problem-focused patient plans...Full timeWork at office
- ...ensuring the financial stability of the organization by managing the authorization processes for surgical procedures and patient admissions. This... .... Obtaining timely and accurate authorization information, prior to performing services, reduces claim denials, ensures payer...
$20.55 - $33.93 per hour
...of medical expenses incurred. Obtains and verifies coverage authorizations for referrals, medications, and procedures, ensuring financial... ...level providers to schedule peer‑to‑peer discussions to obtain prior authorization of services denied by the patient’s insurance....Shift work$18.13 - $29.9 per hour
...information. Provides routine information to callers and gives only authorized medical advice from a provider. Provides a high level of... ...required insurance co-pays from patients including any prior balances. Follows scheduling notes and direct schedules patient...Daily paidWork at officeShift workWeekend workBrown University Health
Providence, RI5 hours agonew- ...visit planning by reviewing charts, identifying required labs or authorizations, and communicating key information to providers Execute... ...Manage medication coordination activities, including prior authorizations and treatment plan documentation, to ensure uninterrupted...Full timeInternshipWork at officeFlexible hoursShift work
East Bay Community Action Program
Barrington, RI3 days ago - ...research activities. Utilizes all available resources to provide quality, cost effective patient care. Assists in obtaining prior authorizations for bleeding disorder medications Meets and maintains clinical competencies measured by pre-determined credentialing...Local areaShift work
Lifespan
Providence, RI4 days ago $17 - $25.82 per hour
SUMMARY The Referral Coordinator reports to the Prior Authorization Supervisor. Under the general supervision, coordinates the effective and efficient patient flow regarding pre‑registration scheduling appointments with specialist and testing per physician request. Obtains...Work at officeShift work- ...medication lists. Data enter health information into the electronic health record. Work with Nurses and Prescribers to obtain prior authorizations for medications. Work with Practice Manager, Nurses and Prescribers to process medication refill requests. Maintain...Full timeShift work
Thrive Behavioral Health
Providence, RI2 days ago $18.13 - $29.9 per hour
...testing as required. Responsible to inform manager of clinical supply needs or assists with ordering. Responsible to obtain prior authorizations and/or insurance referrals as per practice need. Works assigned clinical buckets timely. Must be able to work...Work at officeRemote workMonday to FridayRotating shiftDay shiftLifespan
Providence, RI8 days ago- ...supplies. Perform general office duties, such as answering telephones, and completing insurance forms. Completing pre authorizations and prior authorizations. Maintain ongoing tracking and appropriate documentation of referrals. Review details and...Full timeImmediate startRelocation packageFlexible hoursDay shift
Wood River Health Services Inc
Hope Valley, RI4 days ago - ...Recruiter or Staffing Manager! Job Description Provide professional phone assistance to callers through a criteria-based prior authorization process. Maintain complete, timely, and accurate documentation of all approvals and denials. Conduct data entry and...Full timeRemote workMonday to FridayShift work
A-Line Staffing Solutions
Woonsocket, RI2 days ago $19.23 - $28.85 per hour
Job Posting Title Clinical Pharmacy Technician Sr Job Description Evaluates and authorizes approval of prior authorization pharmacy requests from prescribers received by telephone and/or facsimile using client clinical criteria. Responsibilities Determines appropriateness...Work experience placementLocal areaVisa sponsorshipWork visa$117.6k - $161.7k
...our caring community The Informatics Lead is responsible for providing advanced analytical support and oversight for Medicaid Prior Authorization (PA) reporting. This role will drive informatics initiatives that directly support HCPR Risk Management, Medicaid Customer...Full timeTemporary workRemote work
