This Job listing is about Actalent in 美国 田纳西州 Collegedale 2022 exclusively on us.q4jobs.com
- Coverage reviews and appeals including the review of medication related prior authorizations, pharmacy appeals, and member grievances focused on medications.
- Performs prospective and retrospective coverage reviews and appeals per State and Federal regulations Responds to prescriber, pharmacy provider, member appeals, grievances and complaints related to the provision of pharmaceutical services within established time periods l l
- Builds and maintains decision trees in the prior authorization system l Maintains denial rationale associated with clinical criteria and ensures that decision letters meet regulatory compliance
- Additional Skills & Qualifications:*
- 3 years of experience
- Clinical experience required, and/or completion of 1 year residency and/or board certification Skills\Certifications Ability
- Experience Level:* Expert Level
Actalent connects passion with purpose. Our scalable talent solutions and services capabilities drive value and results and provide the expertise to help our customers achieve more. Every day, our experts around the globe are making an impact. We’re supporting critical initiatives in engineering and sciences that advance how companies serve the world. Actalent promotes consultant care and engagement through experiences that enable continuous development. Our people are the difference. Actalent is an operating company of Allegis Group, the global leader in talent solutions. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
|美国 田纳西州 Collegedale