Jobs in the United States

25+ jobs

Save this search

Added just now
T
Sr Service Coordinator
TIAA
Dallas, TX · Charlotte, NC
- $23.89 to $31.88 USD / hour
…include, depending on the role, participation in an incentive program linked to performance (for example, annual discretionary incentive programs, non-annual sales incentive plans, or other…
Added 12 mins ago
Survey Layout Manager
Sundt
El Paso, TX
8. Will interact with people frequently during a shift/work day
Added 15 mins ago
Area Merchandising Manager- St. Louis, MO
Love's Travel Stops & Country Stores
Saint Louis, MO
At Love’s, At Love's, our values go beyond our name. We look for those same values in our people. The Area Merchandising Manager is a critical element to the success of our long-term…
Added 15 mins ago
Area Merchandising Manager- Indianapolis, IN
Love's Travel Stops & Country Stores
Indianapolis, IN
At Love’s, At Love's, our values go beyond our name. We look for those same values in our people. The Area Merchandising Manager is a critical element to the success of our long-term…
Added 15 mins ago
Area Merchandising Manager- Akron, OH
Love's Travel Stops & Country Stores
Akron, OH
At Love’s, At Love's, our values go beyond our name. We look for those same values in our people. The Area Merchandising Manager is a critical element to the success of our long-term…
Added 15 mins ago
Program Manager, Global Demand and Supply Reconciliation
Google
Atlanta, GA
…everyone, whether down the street or across the globe. As a Program Manager at Google, you’ll lead complex, multi-disciplinary projects from start to finish - working with stakeholders to…
Added 16 mins ago
Aircraft Operations Analyst - E2
Lockheed Martin
Luke AFB, AZ
At Lockheed Martin, we know mission success starts with taking care of our people. Our Total Rewards program is designed to attract top talent, support your well-being, and help you grow -…
Added 16 mins ago
W
(USA) Pharmacy Manager, Store # 05429
Walmart
SURPRISE, AZ
- $112,000 to $197,000 USD / year
…outreach? Do you understand pharmacy operations and leading people? Join Walmart as a Pharmacy Manager and lead our team of pharmacists and pharmacy staff to take care of patients in the…
Added 16 mins ago
Sr. Manager Business Analysis - Medicare / Medicaid
CVS Health
Scottsdale, AZ
The Senior Manager, Strategic Programs Business Solutions Liaison is a senior individual contributor within Medicare business who leads the business-side delivery of complex,…
Added 17 mins ago
Watersheds & Stormwater Subdiscipline Leader Job Details | Black & Veatch Family of Companies
Black & Veatch
Phoenix, AZ
As an employee-owned company, our people are Black & Veatch. We put them at the center of everything we do and empower them to grow, explore new possibilities and use their diverse talents…
Added 17 mins ago
Group Product Manager, Privacy
Ford Motor Company
Phoenix, AZ
…families. You'll see your work on the road every day, helping people move freely and pursue their dreams. At Ford, you can build more than vehicles. Come build what…
Added 20 mins ago
SO
Program Coordinator II - Spartanburg
State of South Carolina
Spartanburg, SC
- $51,039 to $71,706 USD / year
Are you passionate about making a real difference in people's lives? Join our team at the SC Department of Behavioral Health and Developmental Disabilities (BHDD) where we are dedicated to…
Added 20 mins ago
SO
Mental Health Professional II (Spartanburg)
State of South Carolina
Spartanburg, SC
- $61,801 to $69,985 USD / year
As the Mental Health Professional II under limited supervision of the program manager, employee will perform direct clinical services (individual, family, and group therapy) within an…
Added 36 mins ago
AU
Security Officer Full Time Government Building
Allied Universal
Costa Mesa, CA
- $25 USD / hour
- Full-time
…incidents. Join an agile, reliable, and innovative team that puts people first, works together, and acts with…
Added 42 mins ago
T&
Associate Attorney
Tyson & Mendes LLP
San Francisco, CA
- $115,000 to $160,000 USD / year
You will also have access to experienced support professionals, including our long tenured Office Manager, Pilar Romero, along with legal assistant, paralegal, administrative, and trial…
Added 46 mins ago
BA
Test Test
Bradley Angle
Portland, OR
- $50,000 to $55,000 USD / year
exist for all people. Every day, we work towards making this vision a reality, by placing
Added 47 mins ago
DISTRICT HR SPECIALIST District 4 ( Omaha, NE)
The Kroger Co.
Omaha, NE
- Coordinate and deliver (as appropriate) associate training programs, including new hire orientation, manager on duty and department leader development
Added 48 mins ago
STR MGMT/e-COMMERCE SUPERVISOR
The Kroger Co.
North Ogden, UT
Provide feedback to store management team, district manager, field specialist, coordinators and division e-Commerce manager on the effectiveness of operational plans/programs
Added 48 mins ago
Assistant Store Manager
AutoZone
Fremont, CA
As an Assistant Store Manager at AutoZone, you’ll support daily store operations, energize team performance, and drive sales in a fast-paced retail environment. With strong leadership,…
Added 49 mins ago
Assistant Store Manager
AutoZone
Muskegon, MI
As an Assistant Store Manager at AutoZone, you’ll support daily store operations, energize team performance, and drive sales in a fast-paced retail environment. With strong leadership,…
Added 49 mins ago
MANAGER IN TRAINING
AutoZone
Lewes, DE
…executing store operations with excellence. Under the Store Manager’s guidance, MITs lead by example, demonstrating initiative and strong leadership. Through operational oversight and team…
Added 49 mins ago
MANAGER IN TRAINING
AutoZone
Seaford, DE
…executing store operations with excellence. Under the Store Manager’s guidance, MITs lead by example, demonstrating initiative and strong leadership. Through operational oversight and team…
Added 49 mins ago
Biolife EMT - $3,500 Signing Bonus
USA - 3387 BioLife Plasma Services, LP
MO
…and quality is expected. You will report to the Plasma Center Manager and will perform as a Medical Support Specialist to support plasma center…
Added 49 mins ago
A
Part Sales Manager – Full Time
AutoZone
Monroe, WA
- Full-time
…executing store operations with excellence. Under the Store Manager’s guidance, MITs lead by example, demonstrating initiative and strong leadership. Through operational oversight and team…
Added 49 mins ago
A
Part Sales Manager – Part Time
AutoZone
Waco, TX
- Part-time
…executing store operations with excellence. Under the Store Manager’s guidance, MITs lead by example, demonstrating initiative and strong leadership. Through operational oversight and team…

Fallon Health

Prior Authorization Coordinator

Worcester, MA, United States

Apply About employer

Applications open in a new tab.

Job details

Pay: In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is around $23 - $24/hour, which reflects what we reasonably and in good faith expect to pay at the time of posting.
Apply by: Nov 4, 2027
Education: High school diploma
Experience: 1-3 years professional experience in related position, preferably in health care.
Posting language: English
Posted: Nov 4, 2026

Original job description

Overview

About us:

Fallon Health is a company that cares. We prioritize our members - always - making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs - including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly) - in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.

Brief Summary of Purpose:

The FH authorization process is an essential function to FH’s compliance with CMS regulations, NCQA standards, other applicable regulatory requirements, and customer expectations. The FH Authorization Coordinator serves to administer the FH prior authorization process as outlined in the Plan Member Handbook/Evidence of Coverage, departmental policies and procedures, and regulatory standards. The Authorization Coordinator serves as a liaison between FH members and/or provider offices and FH with their authorization management issues. Thorough research, documentation, and corrective action planning must be established for each respective case and adjudication completed in accordance with existing regulations, policies, and standards.

Responsibilities

Job Responsibilities:

Administers FH authorization processes as outlined in Member Handbook/Evidence of Coverage for all products, and in compliance with applicable CMS and NCQA standards and other state or federal regulatory requirements. Strictly adheres to department turn-around time standards established in accordance with regulatory standards.
Enters, researches, investigates, and documents all authorizations from receipt to notification into QNXT and/or TruCare for all product lines.
Approves authorizations when the authorization meets the criteria listed in the appropriate Prior Authorization Protocol, authorizations not meeting protocol parameters are prepared for review, including direct contact with physician’s offices and physicians to obtain records and other clinical information in support of the request; ensures that all pertinent information accompanies requests for further review.
Notifies members and providers of any additional instructions necessary once authorization approval has been obtained from the reviewers; answers questions and provides direction and support.
Works with Department Supervisors, Manager and/or Director, or Clinical Staff including the Medical Directors to resolve issues; formulates improvement measures and response to members; prepares written correspondence to members.
Print and mail member notification letters at the FH corporate office located at 10 Chestnut Street, Worcester, MA several times per month or as needed, as designated through a rotational in-office calendar or at the direction of a supervisor or manager.
Adheres to department standards for completion of authorization turn-around time and notification.
Accepts authorizations for FH members, screens for member eligibility and enters information into the FH Core system.
Answers authorization questions from members and providers, as needed.
Answers telephone calls via ACD queue, as needed, within the Plan’s standards for quality and service.
Communicates both by telephone and on-site, as needed, with FH providers and staff to facilitate the Pre-Authorization Process.

Qualifications

Education:

High School Diploma required; College degree (B.S. or B.A.) or equivalent preferred

License/Certifications:

Medical Terminology or Medical Coding helpful

Experience:

1-3 years professional experience in related position, preferably in health care.
Experience in a managed care or call center setting or physician’s office; knowledge of managed care and/or utilization management strategies advisable
Excellent writing skills with familiarity and comfort with medical terminology.
Ability to work independently and make appropriate decisions within the realm of set business and benefit guidelines
Excellent interpersonal communication and problem-solving skills.
Excellent research and documentation skills.
Excellent writing skills.
Computer literate, particularly in Windows based applications (Word, Excel, PowerPoint, and Access).

Pay Range Disclosure:

In accordance with the Massachusetts Wage Transparency Act, the pay range for this position is around $23 - $24/hour, which reflects what we reasonably and in good faith expect to pay at the time of posting. Final compensation will depend on the candidate’s experience, skills, and fit with the role’s responsibilities.

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

Apply About employer

More about this job

Skills

Medical terminology
Medical coding
Work independently
Communication skills
Problem solving
Research
Documentation
Computer skills
Microsoft Windows
Microsoft Word
Microsoft Excel
Microsoft PowerPoint
Microsoft Access

Report this job