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Akido
Overview
Review and process prior authorization requests for outpatient services to ensure medical necessity and compliance with health plan requirements. Collaborate with providers and Medical Directors to document clinical determinations and maintain regulatory standards.
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Compensation
$62,400 - $93,600 / YEAR
Posted
14 days ago
Humana
Conduct comprehensive clinical reviews of prior authorization requests for behavioral health services to determine medical necessity and benefit eligibility. Coordinate with healthcare providers and medical directors while documenting findings in clinical systems to ensure regulatory compliance.
Salary not listed
15 days ago
Blue Shield of California
Conduct clinical reviews of mental health and substance use authorization requests to determine medical necessity and coding accuracy. Perform prospective and concurrent utilization reviews using evidence-based guidelines and clinical criteria.
$34 - $57 / HOUR
21 days ago
Capital Health (US)
Performs clinical chart reviews to determine the appropriateness of patient care levels and ensures compliance with regulatory guidelines. Collaborates with medical staff and payers to manage patient progression, reduce length of stay, and optimize resource utilization.
$39 - $51 / HOUR
1 month ago
UnitedHealth Group
The role involves implementing daily telephonic case management interventions for high-risk members by assessing needs and coordinating discharge plans with clinical teams while following members in the acute inpatient setting. Key duties include evaluating discharge needs, coordinating post-discharge care with providers, participating in rounds, and arranging necessary post-hospital services.
$60,200 - $107,400 / YEAR
3 months ago
