Current jobs related to Prior Authorization Specialist - Lansing - Emergent Holdings
-
Pharmacy Prior Authorization Specialist
7 days ago
Lansing, Michigan, United States Tekwissen Full timeJob Title: Prior Authorization SpecialistAt Tekwissen Group, we are seeking a highly skilled Prior Authorization Specialist to join our team. As a Prior Authorization Specialist, you will play a critical role in ensuring that our clients receive the necessary approvals for their pharmacy claims.Responsibilities:Process prior authorization requests under the...
-
Field Sales Specialist
4 weeks ago
Lansing, Michigan, United States Robert Bosch Group Full timeField Sales Specialist (Professional Channel) for Michigan - Robert Bosch GroupAs a prominent player in the industry for over two decades, the Robert Bosch Group is renowned for its high-quality construction tools, including premium circular saw blades, reciprocating blades, and various drill bits designed for exceptional performance under the most...
-
Pharmacy Technician Specialist
4 days ago
Lansing, Michigan, United States Strategic Staffing Solutions Full timePharmacy Technician Job DescriptionJob Summary:We are seeking a highly skilled Pharmacy Technician to join our team at Strategic Staffing Solutions. As a Pharmacy Technician, you will play a critical role in supporting providers with Medicare Part D and/or Commercial pharmacy/specialty drug benefits analysis, drug coverage inquiries, and prior...
-
Pharmaceutical Care Specialist
3 weeks ago
Lansing, Michigan, United States ICONMA Full timePosition Overview:The Clinical Pharmacist will be responsible for evaluating Part B medical drug prior authorization requests in accordance with CMS regulations and clinical coverage standards.Key Responsibilities:- Communicate with prescribers and infusion centers to verify information, relay case outcomes, and discuss clinical details.- Promote effective...
-
Pharmaceutical Care Specialist
4 weeks ago
Lansing, Michigan, United States ICONMA Full timePosition Overview:The Clinical Pharmacist will be responsible for evaluating Part B medical drug prior authorization requests in accordance with CMS regulations and clinical coverage standards.Key Responsibilities:- Communicate with prescribers and infusion centers to verify information, relay case outcomes, and discuss clinical details.- Promote the...
-
Clinical Medication Specialist
4 weeks ago
Lansing, Michigan, United States ICONMA Full timePosition Overview:The Clinical Pharmacist will evaluate Part B medical drug prior authorization requests in accordance with CMS regulations and clinical coverage standards.Key Responsibilities:- Communicate with prescribers and infusion centers to verify information, convey case outcomes, and discuss clinical details.- Promote appropriate and efficient...
-
IT Security Specialist
3 weeks ago
Lansing, Michigan, United States Tekwissen Full timeJob SummaryWe are seeking an experienced IT Security Specialist to join our team at Tekwissen Group. As an IT Security Specialist, you will be responsible for completing and maintaining system security plans (SSP) for new and existing systems.Key ResponsibilitiesSystem Security Planning: Create system security plans (SSP) for new applications in alignment...
-
Pharmacy Technician Specialist
10 hours ago
Lansing, Michigan, United States CVS Health Full timeJob SummaryThe Pharmacy Technician I is the initial point of contact for Prior Authorization requests from members, providers, and a diverse customer base. This role requires proficiency in pronouncing drug names and diagnosis, as well as recognizing medical terminology. The successful candidate will be responsible for maintaining complete, timely, and...
-
IT Security Specialist
3 weeks ago
Lansing, Michigan, United States GSK Solutions Full timeJob SummaryJob Title: IT Security SpecialistLocation: RemoteDuration: 1 year with possible extensionPay Rate: $45/hrAbout the Role:The IT Security Specialist will be responsible for completing and maintaining system security plans (SSPs) for new and existing systems. This requires close coordination with IT project teams, business and enterprise security...
-
Clinical Pharmacist/Pharmacist
3 days ago
Lansing, Michigan, United States w3r Consulting Full timeJob SummaryWe are seeking a highly skilled Clinical Pharmacist to join our team at w3r Consulting. As a Clinical Pharmacist, you will play a critical role in reviewing Part B medical drug prior authorization requests and promoting appropriate utilization review of prescription drug claims among participating physicians.Key ResponsibilitiesReview Part B...
-
Risk Management Specialist
3 weeks ago
Lansing, United States Colliers Engineering & Design Full timeOverview Colliers Engineering & Design is seeking a Risk Management Specialist to support our Risk Management team! This individual will report to the Director of Risk Management, collaborate with team members, play an integral role in implementing and optimizing procedures, researching and processing professional licenses company-wide. The Risk Management...
-
Risk Management Specialist
3 weeks ago
Lansing, United States Colliers Engineering & Design Full timeOverview: Colliers Engineering & Design is seeking a Risk Management Specialist to support our Risk Management team! This individual will report to the Director of Risk Management, collaborate with team members, play an integral role in implementing and optimizing procedures, researching and processing professional licenses company-wide. The Risk Management...
-
Procurement Specialist
4 weeks ago
Lansing, Michigan, United States Jones Lange Lasalle, Inc. Full timePosition OverviewThe role of a Sourcing Specialist at Jones Lang LaSalle, Inc. involves becoming a key authority in the execution of sourcing strategies, fostering supplier partnerships, and overseeing program management.Key ResponsibilitiesAct as a subject matter expert in the development and implementation of sourcing strategies.Engage collaboratively with...
-
Clinical Pharmacist/Pharmacist
1 month ago
Lansing, United States ICONMA Full timeEngagement DescriptionThe pharmacist will review Part B medical drug prior authorization requests according to CMS regulations and clinical coverage criteria.Call prescribers and infusion centers to confirm information, deliver case outcomes, and discuss clinical information.Responsible for promoting appropriate and/or efficient utilization review of...
-
Client Support Specialist
3 weeks ago
Lansing, Michigan, United States TEKsystems Full timeJob OverviewPOSITION SUMMARYThis role involves providing assistance to clients via telephone for a governmental organization. As a Client Support Specialist (CSS), you will manage inquiries from U.S. citizens, utilizing a computer system to deliver information on a variety of subjects. The ideal candidates will possess excellent communication abilities and a...
-
Rebar Fabrication Specialist
2 weeks ago
Lansing, Michigan, United States Nucor Corporation Full timeJob SummaryNucor Corporation is seeking a skilled Rebar Fabrication Specialist to join our team in Lansing, MI. As a Rebar Fabrication Specialist, you will be responsible for bending, cutting, bundling, and loading reinforcing steel bars in accordance with customer orders.Key ResponsibilitiesBend, cut, bundle, and load reinforcing steel bars in accordance...
-
Identity Access Management Specialist
2 weeks ago
Lansing, United States Stride Full timeJob Description Summary: Identity Access Management (IAM) Specialist at Stride is responsible for designing, implementing, and maintaining the organization's identity governance, management, and privileged access management technologies. This role ensures that identity and access systems are secure, efficient, and integrated seamlessly within the IT...
-
Clinical Pharmacist/Pharmacist
3 months ago
Lansing, United States ICONMA Full timeEngagement Description The pharmacist will review Part B medical drug prior authorization requests according to CMS regulations and clinical coverage criteria. Call prescribers and infusion centers to confirm information, deliver case outcomes, and discuss clinical information. Responsible for promoting appropriate and/or efficient utilization review of...
-
Homologation Specialist
1 week ago
Lansing, United States Zobility Full timeJob Description The Homologation Specialist is the in-house regulatory requirements lead for various systems and components. This Specialist must evaluate designs and create a certification plan. They assist engineering in the development of systems as well as assist in negotiation with foreign government(s) to accept compliance documentation from the...
-
Sanitation Specialist
3 weeks ago
Lansing, Michigan, United States J.O Cleaning Service Full timeJob OverviewWe are in search of a dedicated Sanitation Specialist to become a part of our team. In this role, you will be tasked with ensuring a pristine and organized environment.Key Responsibilities:Maintain facilities in a clean and orderly state.Execute cleaning tasks including floor maintenance.Conduct routine upkeep duties.Organize cleaning supplies...
Prior Authorization Specialist
4 months ago
SUMMARY:
Support BCBSM and BCNA providers (pharmacists and physicians) with Medicare Part D drug coverage inquiries, Grievances, and prior authorizations.
RESPONSIBILITIES/TASKS: (Brief bullet points detailing the tasks for this position)
- Answer telephones in an efficient and timely manner to lend appropriate assistance to providers.
- Process prior authorization requests under the supervision of a Clinical Pharmacist. -
- Apply pharmacy prior authorization criteria used in the adjudication of pharmacy PA requests.
- Analyzing written, faxed, and verbal inquiries which leads to entry of pharmacy authorizations into the system.
- Communicate coverage determination status to physicians and/or members and effectuate such decisions within the authorization tool.
- Troubleshoot problems, inquiries, and new processing procedures for coverage determinations.
- Perform other related duties as assigned.
This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.
EMPLOYMENT QUALIFICATIONS:
EDUCATION OR EQUIVALENT EXPERIENCE:
High School Graduate of GED equivalent required. Two (2) years of college preferred.
EXPERIENCE:
- Two (2) years' experience in retail or hospital Pharmacy required.
- Pharmacy Technician Certification (PTCB) preferred.
- Knowledge of prescription drug names, therapeutic classes, and claims processing
- Experience with Medicare Part D prescription benefits may be preferred for some positions.
- Understanding of formularies and utilization management edits
- Familiarity with Medicare Guidelines and Timeframes
- Computer Literate (Microsoft Office Products).
- Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.
- Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
WORKING CONDITIONS:
Work is performed in an office setting with no unusual hazards.
PAY RANGE:
Actual compensation decision relies on the consideration of internal equity, candidate's skills and professional experience, geographic location, market, and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $44,900 and $75,100.
The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge, and ability levels associated with performing the duties and responsibilities contained in this job description.
We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.
