Top 139 Prior authorization Jobs in Baltimore Md

RN Manager Grievances & Appeals
MedStar Health —Columbia, MD
- $102,606 - $196,996 a year
- Full-time
- Microsoft Word
- Nursing
- Microsoft Excel
4d
Authorization Specialist
The Centers for Advanced Orthopaedics LL —Baltimore, MD
- Remote
- English
- Mid-level
- High school diploma or GED
Quick Apply
Patient Service Representative
Prism Vision Group —Baltimore, MD
- $18.00 - $31.89 an hour
- Computer literacy
- HIPAA
- English
Mental Health Front Desk
Nurse Practitioner On Call LLC —Baltimore, MD
- $21 - $24 an hour
- Full-time
- Spanish
- HIPAA
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
Patient Access Representative I
University of Maryland Medical System —Baltimore, MD
- $17.00 - $21.39 an hour
- Full-time
- Hospital
- Administrative experience
- High school diploma or GED
8d
Patient Coverage Verification Specialist
Chase Brexton Health Care —Baltimore, MD
- $19.37 - $25.04 an hour
- Full-time
- Bilingual
- HIPAA
- Mid-level
Quick Apply
Specialty Pharmacy Liaison
Optum —Baltimore, MD
- $17.98 - $32.12 an hour
- Full-time
- Pass drug screening
- Clinic experience
- High school diploma or GED
Patient Accounts Coordinator - Auth and Elig Specialist
Gilchrist Hospice Care, Inc. —Hunt Valley, MD
- $19.92 - $29.87 an hour
- Full-time
- Mid-level
- High school diploma or GED
- Organizational skills
Quick Apply
4d
Patient Service Representative - Endocrinology
Clinical Associates, P.A. —Towson, MD
- Full-time
- Basic math
- High school diploma or GED
- Travel
- Health insurance
- Dental insurance
Quick Apply
Patient Access Representative III
University of Maryland Medical System —Glen Burnie, MD
- $20.47 - $28.64 an hour
- Full-time
- Hospital
- Mid-level
- 3 years
Pharmacy Benefit Coordinator
Maryland Care Management Inc —Linthicum, MD
- $67,000 - $72,000 a year
- Full-time
- Remote
- Writing skills
- Mid-level
- High school diploma or GED
- Disability insurance
- Health insurance
5d
Prior Authorization Representative
Clinical Associates, P.A. —Towson, MD
- Full-time
- Medical office experience
- English
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
9d
Medical Office Coordinator (Neurology)
Johns Hopkins University —Baltimore, MD
- $16.20 - $28.80 an hour
- Full-time
- Background check
- Surgery
- Mid-level
8d
Administrative Assistant
Aspire Wellness Center —Nottingham, MD
- $20 - $22 an hour
- Full-time
- Google Workspace
- HIPAA
- Administrative experience
- Health insurance
- Dental insurance
Quick Apply
Prior Authorization Certified Pharmacy Technician
Shields Health Solutions —Baltimore, MD
- $19.45 - $22.21 an hour
- Remote
- Microsoft Excel
- Microsoft Outlook
- Research
Quick Apply
6d
Surgery Scheduler
PRECISION ORTHOPEDICS AND SPORTS MEDICINE LLC —Fulton, MD
- $20 - $26 an hour
- Full-time
- Private practice
- Surgery
- Mid-level
- Mileage reimbursement
- Health savings account
Quick Apply
Office Assistant (School of Medicine, Pediatric GI)
Johns Hopkins University —Baltimore, MD
- $15.70 - $25.25 an hour
- Monday to Friday
- Hybrid work
- Background check
- Office
- High school diploma or GED
Client Service Representative
Healthcare For the Homeless Inc —Baltimore, MD
- $17 - $19 an hour
- Full-time
- Spanish
- Writing skills
- HIPAA
Quick Apply
Pharmacy Secretary
Greater Baltimore Medical Center, Inc. —Baltimore, MD
- $17.30 - $25.11 an hour
- Full-time
- Word processing
- Writing skills
- Basic math
Quick Apply
Customer Service Representative
Procare Ambulance of Maryland, Inc. —Rosedale, MD
- $18 - $22 an hour
- Part-time
- Basic math
- HIPAA
- Entry level
- Paid time off
- Employee assistance program
Quick Apply

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RN Manager Grievances & Appeals

MedStar Health -
Columbia, MD

Apply Now

Job Details

Full-time
$102,606 - $196,996 a year
4 days ago

Qualifications

Nursing
RN License
Supervising experience
Bachelor's degree
Case management
Utilization management
Resource utilization in healthcare
Bachelor's degree in nursing
Certified Case Manager
General management
Hospital experience
Nursing

Full Job Description

About this Job: General Summary of Position
Responsible for day to day oversight and management of Intake Clinical Appeals Claims Appeals Complaints Grievances and Intake functions. The Manager of Appeals Complaints and Grievances will be dedicated to delivering service and operational excellence through a focus on continuous improvement in the areas of contribution competencies and performance of the Intake Appeals Complaints and Grievances team. This role will be tasked with overseeing intake the development and operational execution of all appeals (clinical and non-clinical) complaints and grievance processes in line with regulatory standards while enhancing quality and effectiveness. Additionally the role will need to utilize advanced technical knowledge to resolve complex issues. This involves setting objectives creating policies and procedures determining approaches allocating resources and managing inventory.

Primary Duties and Responsibilities

Oversees and provides direction for Intake Appeals (Clinical and Claims) Retrospective Review Emergency Room Review and Customer Service/Complaints/Grievances for all lines of business.
Oversees and analyzes critical data and reporting as required by MedStar Family Choice for areas of responsibility. Ensures appropriate data collection and timely submission.
Develops and contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Ensures compliance with hospital/facility policies and procedures and governmental/accreditation regulations.
Actively participates with annual strategic planning objectives for MedStar Family Choice. Initiates innovative ideas and programs to improve quality while maintaining or reducing medical expense.
Provides oversight to ensure that retrospective events appeals and complaints/grievances timeframes are in compliance with NCQA EQRO State of Maryland District of Columbia Federal and any other applicable standards.
Maintains working knowledge of MFC authorization rules for MD and DC and facilitates appropriate training to ensure that MFC associates practitioners facilities and vendors are aware of authorization rules.
Acts as the clinical liaison with IT and subject matter expert for Appeals Grievances and Customer Service with respect to the clinical software system. Maintains close affiliation with the support service team to ensure the system operations meet departmental functions troubleshoots issuers coordinates testing for system upgrades and coordinates appropriate training for associates. Acts as a resource to staff using the software.
Oversees the selection orientation training program and assignment of new and current associates. Maintains up to date training manuals for assigned departments.
Develops standards of performance evaluates performance and conducts performance management planning. Initiates or makes recommendations for personnel actions. Maintains ongoing communication with subordinates to review programs provide feedback discuss new developments and exchanges information.
Participates in multidisciplinary quality and service improvement teams as appropriate. Participates in meetings serves on committees and represents the department and hospital/facility in community outreach efforts as appropriate.
Performs other duties as assigned.

Minimal Qualifications
Education

Bachelor's degree in Nursing required

Experience

3-4 years Utilization management experience required and
5-7 years Diverse clinical experience in a hospital or medical setting required and
1-2 years 2 years supervisory experience required
Additional experience with appeals and grievances preferred

Licenses and Certifications

RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in the State of Maryland upon hire and valid RN licensure in the District of Columbia (DC) prior to start date in position. Upon Hire required and
CCM - Certified Case Manager Active Certified Case Manager (CCM) or CCM certification within 1 Year required

Knowledge Skills and Abilities

Excellent verbal and written communication skills.
Proficient in Microsoft Word Excel and PowerPoint.

This position has a hiring range of : USD $102,606.00 - USD $196,996.00 /Yr.

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Refine Your Search

prior authorization jobs in baltimore md

RN Manager Grievances & Appeals

Authorization Specialist

Patient Service Representative

Mental Health Front Desk

Patient Access Representative I

Patient Coverage Verification Specialist

Specialty Pharmacy Liaison

Patient Accounts Coordinator - Auth and Elig Specialist

Patient Service Representative - Endocrinology

Patient Access Representative III

Pharmacy Benefit Coordinator

Prior Authorization Representative

Medical Office Coordinator (Neurology)

Administrative Assistant

Prior Authorization Certified Pharmacy Technician

Surgery Scheduler

Office Assistant (School of Medicine, Pediatric GI)

Client Service Representative

Pharmacy Secretary

Customer Service Representative

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