Senior Pharmacy PA/Appeals Technician Optum is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by
Essential Duties and Responsibilities: - Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations. - Render medical necessity determinations for Medicare State East cases assigned. - Resolve all other technical issues within Medicare
Essential Duties and Responsibilities: - Lead and execute sensitive, high-risk investigations (e.g., harassment, discrimination, retaliation, serious misconduct), including matters involving senior leaders and significant organizational risk; gather evidence, conduct interviews, assess credibility, and document findings. -
Essential Duties and Responsibilities: - Review cases and summarize the facts of each case and assess issues involved in the case to certify or non-certify requested treatments. - Provide written clinical rationales for CA Workers Compensation cases. - Review, organize
Essential Duties and Responsibilities: - Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations. - Render determinations for cases assigned. - Resolve all other technical issues within reconsideration assigned. - Review cases or sites