Responsibilities
- Supports peer-to-peer (P2P) processes, including scheduling P2P between Medical Directors and providers according to internal policies and requirements
- Manages and reviews Medical Director’s workflow queue in the medical management system and adjusts workflows as needed based on escalations and scheduling
- Schedules peer-to-peer (P2P) between Medical Directors and providers to discuss clinical services including the approval of a prior authorization
- Manages turn-around times for P2P authorizations to ensure P2P are conducted within a timely manner in accordance with regulations and policies
- Develops in-depth knowledge of P2P process, best practices, and internal policies and requirements
- Serves as front-line support in communicating with providers and/or vendors
- Provides support with all communications between clinical staff, providers, and Medical Directors
- Works with different teams to identify process improvements and efficiencies within the P2P process
- Performs other duties as assigned
- Complies with all policies and standards
Requirements
- High School diploma or GED
- 2 - 4 years of related experience
Nice to Have
- Strong knowledge of medical terminology and practices
Benefits
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
Work Arrangement
Remote (Worldwide)
Additional Information
- Work schedule will be based on Eastern time zone
- Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status
- Total compensation may also include additional forms of incentives
- Benefits may be subject to program eligibility
- Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
