Top 92 Prior authorization work from home Jobs in Nashville, Tn

Pharmacy Operations Coordinator- Remote
American Health Plans —Franklin, TN
- Remote
- Mid-level
- High school diploma or GED
- Analysis skills
Quick Apply
8d
Medicaid Eligibility Advocate
TriStar Centennial Medical Center —Nashville, TN
- Full-time
- Reliable transportation
- Entry level
- Employee stock purchase plan
- Disability insurance
Quick Apply
Tool & Die Maker
Precision Castparts Corp. —Nashville, TN
- Overtime
- 5 years
- High school diploma or GED
- Trade school
- Paid holidays
- 401(k) matching
Property Restoration Mitigation Specialist
AccuWorks —Nashville, TN
- $24 an hour
- 8 hour shift
- Background check
- Clean driving record
- Pass drug screening
- Health insurance
- Dental insurance
Quick Apply
Junior Level Building Assessor (InterNACHI and/or Vermin Inspection background preferred)
Bureau Veritas Building Assessments & Project Management —Nashville, TN
- $24 an hour
- 8 hour shift
- Background check
- Clean driving record
- Customer service
- Health savings account
- AD&D insurance
Quick Apply
1d
Residential Cleaner – Join a Team That Has Your Back — Nashville & Surrounding Areas
Doge Home Services LLC —Nashville, TN
- $17.60 - $20.00 an hour
- Part-time
- Background check
- No experience needed
- English
- Paid training
- Mileage reimbursement
Quick Apply
8d
Medical Office Specialist
TriStar Orthopedic Oncology —Nashville, TN
- Full-time
- Mid-level
- Employee stock purchase plan
- Disability insurance
Quick Apply
Manager, Global Trade (Remote)
Raytheon —Nashville, TN
- $107,500 - $204,500 a year
- Full-time
- Remote
- 5 years
- Analysis skills
- Continuous improvement
- Paid holidays
- Disability insurance
13d
Tier II Support Specialist - Healthcare
Proven Business Systems LLC —Franklin, TN
- $65,000 - $80,000 a year
- Full-time
- Computer science
- Computer Science
- Mid-level
- Paid parental leave
- Health savings account
4d
Project Coordinator
Franke —Smyrna, TN
- Word processing
- Computer literacy
- Basic math
- Paid holidays
- Health insurance
Sr. Specialist, Sales Development
Concentrix —Nashville, TN
- $19.18 - $21.19 an hour
- Urgently hiring
- Remote
- Mid-level
- Residential
- Microsoft Office
- Paid training
- Paid holidays
Epic Certified Willow Inpatient Analyst 5340180
Accenture —Nashville, TN
- $52 - $56 an hour
- Full-time
- Remote
- System design
- HIPAA
- Mid-level
- Disability insurance
- Health insurance
Director of Revenue Operations - Nashville (Hybrid)
ForMotion Clinic —Nashville, TN
- Full-time
- Finance
- Master's degree
- Analysis skills
- Paid holidays
- Health insurance
Oncology Financial Coordinator
TriStar Centennial Medical Center —Nashville, TN
- Full-time
- Mid-level
- 3 years
- Children
- Employee stock purchase plan
- Disability insurance
Quick Apply
MBA/CPA Finance Leadership Development Program Associate
The Cigna Group —Franklin, TN
- $100,800 - $168,000 a year
- Online Application
- Hybrid work
- CPA
- Mid-level
- Office
- Paid holidays
- Relocation assistance
REMS Program Specialist
Tennessee Oncology —Nashville, TN
- Full-time
- Nursing
- Clinic experience
- Mid-level
Quick Apply
14d
Automotive Maintenance Coordinator - Remote
Enterprise Mobility —Nashville, TN
- $20.51 - $23.51 an hour
- Full-time
- 18 years or older
- Microsoft Excel
- Microsoft Outlook
- Profit sharing
- Health savings account
16h
Sales Development Representative
Galileo —Nashville, TN
- $75,000 a year
- Remote
- Research
- Mid-level
- 3 years
- Health savings account
- AD&D insurance
Quick Apply
1d
Medical Assistant
Nurture Pediatrics PLLC —Nolensville, TN
- Full-time
- Private practice
- Pass drug screening
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
Registered Nurse
Mental Health Cooperative —Nashville, TN
- $32 - $35 an hour
- Full-time
- Nursing
- RN License
- Mid-level
- Health savings account
- AD&D insurance
12d

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prior authorization work from home jobs near nashville, tn

Pharmacy Operations Coordinator- Remote

American Health Plans -
Franklin, TN

Quick Apply

Job Details

8 days ago

Qualifications

Medicare
Team leadership
CMS
Pharmacy Technician License
High school diploma or GED
CMS regulatory compliance
Medicare regulations
Data interpretation
Pharmacy Technician Certification

Full Job Description

The Pharmacy Operations Coordinator is responsible for performing oversight and monitoring of the pharmacy benefit manager (PBM), for activities related to the appropriateness of claims adjudication, and for providing support of CMS regulatory requirements, and other Plan Operations.

ESSENTIAL JOB DUTIES:

To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation.

Serve as primary contact between Plan and PBM

Perform PBM oversight and monitoring

Report and escalate performance deficiencies and status to management and the compliance department

Formulary Management: Recognize formulary requirements: non-formulary, prior authorization (PA), Step Therapy (ST), Quantity Limit (QL) and review, outreach, and track rejected pharmacy claims

Responsible for ensuring regulatory requirements are met for coverage determinations/redeterminations

Lead annual readiness

Serve as a liaison with Enrollment Department to ensure appropriate member eligibility processing

Support CMS Plan reporting, audits, and monitoring activities and submissions

Assist and track in-coming calls from agents, pharmacies, nursing homes, providers/nurses, and members

Coordinate monthly website updates

Monitor and report on departmental metrics

May be assigned to work on special projects and business initiatives

Other duties as assigned

JOB REQUIREMENTS:

Maintain regular and reliable attendance

Attention to detail

Ability to work in a high demand fast pace environment

Experience in planning and implementation

Strong analytical skills

Strong leadership and collaboration skills

Extensive knowledge in Medicare compliance

Customer and quality focus

Follow-up and solve any open items in a timely manner

Adhere to all compliance requirements

Adhere to Centers of Medicare and Medicaid Services (CMS) regulations

Successful completion of required training

Handle multiple priorities effectively

Independent discretion/decision making

Make decisions under pressure

REQUIRED QUALIFICATIONS:

Education:

o High school diploma or equivalent required

Experience:

o Experience in the pharmacy department of a Medicare Advantage or Part D plan is preferred

License/Certification(s):

o Pharmacy technician

Licenses & Certifications

Required

Pharmacy Tech

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the Department of Labor.

Quick Apply

Refine Your Search

prior authorization work from home jobs in nashville, tn

Pharmacy Operations Coordinator- Remote

Medicaid Eligibility Advocate

Tool & Die Maker

Property Restoration Mitigation Specialist

Junior Level Building Assessor (InterNACHI and/or Vermin Inspection background preferred)

Residential Cleaner – Join a Team That Has Your Back — Nashville & Surrounding Areas

Medical Office Specialist

Manager, Global Trade (Remote)

Tier II Support Specialist - Healthcare

Project Coordinator

Sr. Specialist, Sales Development

Epic Certified Willow Inpatient Analyst 5340180

Director of Revenue Operations - Nashville (Hybrid)

Oncology Financial Coordinator

MBA/CPA Finance Leadership Development Program Associate

REMS Program Specialist

Automotive Maintenance Coordinator - Remote

Sales Development Representative

Medical Assistant

Registered Nurse

I want to receive the latest job alert for prior authorization work from home in nashville, tn

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