Average salary: $93,603 /yearly
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$37.66 - $44.33 per hour
...Working under technical direction and within significant limits and authority,adjudicateworkers' compensation claims of higher technical... ...Resumes submitted for this or any other position without prior authorization from Human Resources will be considered unsolicited...SuggestedHourly payTemporary workLocal areaRemote workArgonaut Management Services, Inc
Milwaukee, WI4 days ago- ...BayCare Clinic in Green Bay, WI is looking for a Pre-Verification Specialist to join their team. This role involves obtaining prior authorizations for diagnostic studies and ensuring compliance with insurance processes. The ideal candidate will have strong organizational...SuggestedMonday to Friday
BayCare Clinic
Green Bay, WI5 days ago $19.86 per hour
...here. If you’re looking for a job to love, apply today.Scheduled Weekly Hours:40Emplify Health by Gundersen is looking to add a Prior Authorization Specialist to our team! In this role you will work with hospital departments and insurance companies to obtain the necessary...SuggestedFull timeGundersen Health System
La Crosse, WI2 days ago$100k
...broadmanagementdirection,adjudicate construction defect claims at the highest authority limits on assignments reflecting the highest degree of... ...Resumes submitted for this or any other position without prior authorization from Human Resources will be considered unsolicited...SuggestedFull timeLocal areaRemote workArgonaut Management Services, Inc
Milwaukee, WI4 days ago- ...requirements. Identifies adverse facility trends resulting in returned or denied claims (e.g., repeated failure to obtain prior authorization) and communicates to Intake Administrator for follow-up with Admissions Coordinator Reports status of claims and AR balances...SuggestedFull timePart time
Elroy Health Services
Milwaukee, WI5 days ago - ...Prior Authorization Specialist Neuroscience Group is growing! We are adding to our Prior Authorization team. Neuroscience Group has an immediate opening for a full time Prior Authorization Specialist. This position will work Monday - Friday 8 hours per day. As an integral...SuggestedPermanent employmentFull timeTemporary workSummer workWork at officeImmediate startMonday to Friday
Neuroscience Group
Appleton, WI3 days ago - ...Perform financial clearance of patient accounts by verifying insurance eligibility and benefits. Ensure all notifications and authorizations are completed within the required timeframe. Completes appropriate payor forms related to notification and authorization....SuggestedWork at officeImmediate start
Baylor Scott & White Health
Madison, WI5 days ago - ...Medication Prior Authorization Specialist The specialist prepares and submits required documentation and follows up with insurance providers to secure approvals or resolve denials. They collaborate closely with the clinical team to obtain supporting clinical information...SuggestedWork at office
- ...account management skills. Strong knowledge of dermatology patient access programs, market access, specialty pharmacies and prior authorization pull-through initiatives. Work effectively in collaboration with cross-functional teams. The ability to work effectively in collaboration...SuggestedLocal areaNight shift
Incyte
Wausau, WI2 days ago - ...healthcare, business, finance, or insurance related field Required 2 years of experience in Healthcare Revenue Cycle that includes prior authorization Preferred 2 years of experience in preadmission/precertification Preferred Knowledge of CPT and ICD coding highly desired...SuggestedPart timeWork experience placementShift workDay shift
UW Health
Madison, WI5 days ago $100k
...under limited technical direction and within broad limits and authority, adjudicate highly complex claims, potentially with a significant... ...in each jurisdiction (such as required by New York). ~ Prior experience working with ImageRight and Guidewire strongly preferred...SuggestedFull timeLocal areaRemote workArgonaut Management Services, Inc
Milwaukee, WI4 days ago- ...feedback and ideas, and we invite participation on a variety of projects. The Job: Using appropriate methods, obtains prior authorizations for diagnostic studies, procedures, surgeries, and testing as required by each particular insurance company including Worker...SuggestedFull timePart timeMonday to FridayFlexible hours
BayCare Clinic
Green Bay, WI6 days ago - ...your passion meets purpose. Apply today and help us shape a healthier tomorrow. Job Summary: Receives, reviews and processes prior authorization requests, and inpatient admissions, as it relates to eligibility, benefits and services across all lines of business to...SuggestedPermanent employmentContract workTemporary work
Children's Wisconsin
Milwaukee, WI3 days ago - ...will participate in the following assignments in this role: Clinical Review: Conduct comprehensive clinical reviews of prior authorization requests to determine medical necessity and benefit eligibility. Apply advanced evidence-based clinical guidelines in review...SuggestedFull timeFor contractorsApprenticeshipWork experience placementInternshipRemote workWork from homeHome officeWeekday work
Humana
Madison, WI8 days ago - ...partnership with company leadership. Drive operational excellence. Lead day‑to‑day market operations across growth, intake, prior authorization, training, support, family experience and clinical delivery, using KPIs to hold teams accountable and continuously improve performance...SuggestedFull timeTemporary workLocal area
Abby Care
Wisconsin2 days ago $68.5k - $88.02k
...with URAC and ACHC specialty pharmacy accreditation standards and survey readiness ~ Experience optimizing patient access, prior authorization, and reimbursement workflows ~ Strong analytical skills with experience using data to drive operational and performance improvements...Temporary workLocal areaImmediate startFlexible hoursCardinal Health
Madison, WI3 days ago$18.04 - $35.17 per hour
...operations, including referrals, enrollment, eligibility, service authorization and other administrative related requirements of the IRIS... ...assignments, ongoing eligibility, financial eligibility, welcome calls, prior authorizations, individualized service plan activities and...Hourly payFull timeWork experience placementWork at officeMolina Healthcare
Racine, WI3 days ago$26.41 - $51.49 per hour
Molina Healthcare in Wisconsin is looking for a Registered Nurse (RN) to support clinical member services review. The position involves assessing services for compliance and verifying medical necessity, thus ensuring optimal member outcomes through efficient care delivery...Hourly payWork at officeMolina Healthcare
Madison, WI2 days ago$26.41 - $51.49 per hour
...benefits, eligibility and expected length of stay for requested treatments and/or procedures. • Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. • Processes requests within required timelines. • Refers appropriate...Hourly payWork experience placementWork at officeMolina Healthcare
Waukesha, WI1 day ago- ...A healthcare organization in Wausau, Wisconsin, is seeking a Prior Authorizations Team Lead to oversee surgical, clinic, and physical therapy authorizations. The role involves guiding the team, ensuring timely and compliant submissions, and improving processes. Candidates...
Bone & Joint
Wausau, WI2 days ago $113.7k - $162.4k
JobRx, Inc. seeks a Clinical Pharmacist to support pharmacy solutions programs, including prior authorization criteria development and operational initiatives. You will evaluate drug reviews based on evidence-based research and work closely with physicians on prescribing...Remote workJobRx, Inc.
Wisconsin Rapids, WI6 days ago- ...Gainwell Technologies is seeking a Prior Authorization Pharmacy Technician to support pharmacy benefit management services remotely. The role involves managing provider inquiries, processing authorizations, and ensuring compliant communications. You will need at least...Remote workFlexible hours
Gainwell Technologies
Wausau, WI2 days ago - ...Remote Prior Authorization Pharmacist – Work From Home in Managed Care A c onfidential managed care organization is seeking a motivated Remote Prior Authorization Pharmacist to evaluate prescription requests, ensure medical necessity, and improve patient access to safe...Remote workWork from homeFlexible hours
Pharmacy Careers
Milwaukee, WI5 days ago - ...The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit... ...our team. Job Responsibilities: Evaluate and process prior authorization requests/referrals submitted from contracted and...Work at officeLocal areaWork from homeHome officeMonday to Friday
Network Health
Menasha, WI7 days ago - ...form with patient Educate patient on the exam and exam preparation Manage and place orders for exam medication Requirements Prior Authorization experience is a plus Proven customer service skills Previous patient scheduling, call center or reception experience preferred...Full timeTemporary workCasual workFlexible hours
Shared Medical Services
Deerfield, WI3 days ago $106.2k - $225k
...support and input to clinical programs such as: Health Management (IDT), Drug Utilization Review, Formulary development, and Prior Authorization programs to encourage appropriate, high quality, cost effective drug therapy; and to identify opportunities for improvement in...Hourly payFull timeTemporary workLocal areaRemote workShift workWeekend workHispanic Alliance for Career Enhancement
Wisconsin7 days ago- ...calmly the treatment needs to parent and patient utilizing the prescribed treatment plan. Must be able to recognize and identify prior authorization requirements, along with ensuring signed consent forms. Maintain awareness of comfort and safety needs of patients. Provide...Work at officeFlexible hours
Dormont Manufacturing Company
Wausau, WI2 days ago - ...seeking a Remote Behavioral Health RN Intern for their internship program. The position involves conducting clinical reviews for prior authorization requests, coordinating with healthcare professionals, and documenting findings. Candidates must have an active RN license in...InternshipRemote work
Humana
Madison, WI3 days ago $19.43 - $32.98 per hour
...Hours : 8am-6:30pm EST. Targeted start date: 8/10/26. Must be authorized to work in the U.S. without the need for employment‑based visa... ...guidelines and approvals provided from clinical pharmacists. Respond to prior authorization requests and provide options including submission...Hourly payH1bWork at officeRemote workFlexible hoursCentene Management Company LLC
Wausau, WI2 days ago$106.2k - $225k
...Clinical Pharmacist for a remote position within the United States. Responsibilities include conducting clinical reviews, managing prior authorization processes, and providing clinical guidance on formulary decisions. Qualified candidates must have a Doctor of Pharmacy degree...Remote workHispanic Alliance for Career Enhancement
Wisconsin3 days ago
