Americhoice nj pharmacy prior auth

Transcription

1 Suchen Suche Suche Suche Americhoice nj pharmacy prior auth Human Chorionic Gonadotropin (AZ, Florida Healthy TEENs, HI, MD, NJ, NY, OH, PA, RI) Prior Authorization Form - Community Plan. Continuity of Care Following Termination of Your Participation. Belbuca/Butrans (NJ & NY) Prior Authorization Form - Community Plan. Jentadueto / Kombiglyze XR / Onglyza / Trajenta (Louisiana, New Jersey, Ohio, Washington) Prior Authorization Form - Community Plan. Go Paperless: Good for the planet. Good for you. We're continuously looking for ways to provide greater administrative simplicity for care providers and reduce the costs of doing business with us. Check the Status or Update a Previously Submitted Request for Prior Authorization. This site contains documents in PDF format. PDF (Portable Document Format) files can be viewed with Adobe Reader. If you don't already have this viewer on your computer, download it free from the Adobe website. Colony Stimulating Factors Prior Authorization Form - Community Plan. UnitedHealthcare Establishes Long-term Strategic Partnership with Quest Diagnostics. Exjade (New Jersey, Ohio, Washington) Prior Authorization Form - Community Plan. Looking for the federal government's Medicaid website? Look here at. Imbruvica (AZ, HI, LA, MD, NJ, NY, OH, PA, RI) Prior Authorization Form - Community Plan. Florida Psychotropic Medication Guidelines for TEENren Younger than 13. Austedo (AZ, Florida Healthy TEENs, HI, MD, NJ, NY, NYEPP, OH, PA, RI) Prior Authorization Form - Community Plan. June 2018: Reminder on Clinical Laboratory Improvement Amendments Identification Requirements Policy. Learn more about the Genetic & Molecular Lab Testing Notification / Prior Authorization Process. Paper copies of the network provider directory are available at no cost to members by calling the customer service number on the back of your ID card. Non-members may download and print search results from the online directory. Delegated Providers and Accountable Care Organizations - Capitation and/or Delegation Supplement. Aricept 23mg [Donepezil] (AZ, HI, LA, MD, NJ, NY, OH, PA, RI, WA) Prior Authorization Form - Community Plan. Delegated Providers and Accountable Care Organizations - Capitation and/or Delegation Supplement. Jakafi (AZ, Florida Healthy TEENs, HI, MD, NJ, NY, OH, PA, RI) Prior Authorization Form - Community Plan. Note: This application is available to physicians and facilities, not to pharmacies. Oversees: Marketing, Communications, Community and Member Outreach, Public Website and Portal Administration, Centralized Training, Oversight of Brand Strategy, Message Development and Execution, and Public Relations. Oversees: MHS operations for marketing, provider relations, contracting, provider data management, credentialing, member and provider call centers, and claims. Background: A self-employed, pediatrician for more than 30 years, Dr. Yancy continues to maintain his practice in Indianapolis. Originally from Baton Rouge, La., Dr. Yancy received his Bachelor degree from Southern University at Baton Rouge in Louisiana and his Doctor of Medicine from Creighton University Medical School with residency training at Indiana University Medical Center, Riley Hospital for TEENren. Dr. Yancy was the first African American pediatric resident at Riley hospital, starting in 1976, and is the 2011 recipient of the Creighton University School of Medicine Merit Award. Dr. Yancy serves on the board of Indiana Pediatrics, Inc. and the Joseph Maley Foundation.

2 Oversees: Quality Improvement, Pharmacy, Grievances & Appeals, Medical Directors and advisors, Clinical and Service QI Committee Chair, and NCQA accreditation and certification. Background: Barth serves as the Chief Operating Officer of Managed Health Services (MHS), a health plan serving over 260,000 Hoosiers. Barth joined MHS from the Center for Health Care Strategies in Princeton, NJ, where he was Senior Program Officer focused on the development and testing of Medicaid models that combined the financing, delivery, and administration of health services. Prior, he was Managed Care Director for the State of Indiana's Office of Medicaid Policy and Planning, where he oversaw programs serving both the TANF and Aged, Blind, and Disabled populations. Barth holds a Master's in Social Work from the University of Michigan and serves on the Board of Advisors for Indy Reads. Oversees: Compliance with MHS' state contract and government affairs programs, Grievance & Appeals, Chief Compliance Officer. Oversees: Enrollment, invoicing, HIP program compliance, other aspects of HIP operations. Oversees: Assistance with network providers and various MHS committees, with clinical care standards and medical practice policies, and promoting positive MHS relations with the local medical community. Oversees: Member & Provider Services Customer Service Call Centers, local Claim Operations, customer communication and educational programs and Web portals functions. Background: Daniel Rich came to MHS from Louisiana Healthcare Connections, another Centene plan, where he served as the Senior Director of Operations. He also brings experience as the Corporate Operations Manager for Centene Corporate, among other roles. Originally from St. Louis, Missouri, Rich received his Bachelor of Arts from Dartmouth College. He received his law degree from University of Missouri-Columbia Law School and his Master of Business Administration from Olin Business School at Washington University in St. Louis. Prior to his roles with Centene Corporation, O'Toole spent 16 years with Medco and their predecessor companies acquired by Medco. He started as Division Controller in the Home Care business, and was promoted to Vice President of Finance and later to Vice President of Operations. There, he held roles overseeing the infusion pharmacy business in the central United States and had nationwide operational responsibility for the hemophilia specialty pharmacy operations in Nashville, TN. He also spent 6 years in healthcare consulting with Price Waterhouse and Ernst & Young in St. Louis. O'Toole received his Bachelor of Science in Microbiology, Master of Science in Public Health in Health Administration, and his Master of Business Administration in Finance from the University of Missouri-Columbia. He currently serves on the Board of Directors of Covering TEENs & Families. Background: Ms. Hage has over a decade of experience in state and federal government and the private sector with a focus on public policy, communications and government affairs. Most recently, she was Vice President of Public Policy for United Way of Central Indiana where she led the federal, state and local engagement and policy efforts. She also served as Legislative and Senior Policy Director for the Family and Social Services Administration where she oversaw legislation, policy, administrative rulemaking and communications. Prior to serving in state government, Hage served in several policy, lobbying and communications positions in Washington D.C., including on Capitol Hill, lobbying for the State of Indiana and IU Health and spokeswoman for the Office of the U.S. Trade Representative. Hage holds a bachelor of arts in international marketing and economics from Taylor University. She is a graduate of the Richard G. Lugar Excellence in Public Service Series and is a member of the Women's Fund of Central Indiana OPTIONS Class 16. You will need Adobe Reader to open PDFs on this site. Background: Claypool previously served as director of Medicaid risk for Indiana University Health Plans, which included P&L management for the Medicaid line of business. She also served as the director of Medicaid compliance for Anthem, overseeing compliance functions of 12 state Medicaid managed care contracts, and as the Director of Care Programs for Indiana FSSA. Originally from Warsaw, Indiana, Claypool received her Bachelor of

3 Science in public policy from Indiana University and her Master of Public Affairs from Indiana University-Purdue University Indianapolis (IUPUI). She volunteers with Executive Women in HealthCare. Background: Prior to working at MHS, Petrie served in several leadership roles for WellCare Health Plans, including senior director of program compliance, leading the company's compliance oversight, market liaison and analytics programs. He also has unique expertise as a regulator having overseen compliance for all Medicaid managed care plans for the state of Florida's Agency for Health Care Administration as well as implementation of new programs and policies. Originally from New York and having lived in Tampa, Fla., Petrie received his Bachelor of Arts in political science with a minor in psychology from Emory University in Atlanta, Ga. He is a member of the Health Care Compliance Association, and is a dedicated volunteer for Pop Warner, Special Olympics, Metropolitan Ministries and The Family Café. Background: Dr. Baker joined MHS after serving as chief medical officer at Unison health plans in Greenville, DE, and Pittsburgh, PA. Originally from Margate, NJ, Dr. Baker earned a bachelor's degree at Pennsylvania State University and is a graduate of the Thomas Jefferson University's Jefferson Medical School. He earned an additional masters degree from Carnegie Mellon University in Dr. Baker serves on the Board of Directors of Fathers and Families. Background: Since joining MHS in 2005, Shearer has held the titles of Manager and Director of Member Services and Provider Services. Previously, she worked as Customer Service Director at Maxicare Indiana, a benefit advocate manager at what's known today as AmeriChoice (an enrollment broker) and was one of the first Benefit Advocates at the inception of the Hoosier Healthwise program. Originally from Centerville, IN, Shearer earned her Bachelor's degree at Franklin College. Background: Carlin previously served as senior director of marketing and communications. Prior to MHS, she was in the music and entertainment industry with Live Nation and Live-360. Jo received her Bachelor of Science in Journalism and Political Science from Ball State University. She serves as Secretary of the Board of Directors for Project Home Indy and Chair of the Women's Cabinet for the American Lung Association. Background: Since August 2014, O'Toole has led MHS through tremendous growth and product expansion, procuring and implementing traditional Medicaid, Medicaid expansion, the Aged, Blind and Disabled program including foster care, a Federal Exchange Marketplace product and Medicare Advantage products. Prior to moving to Indiana he served as the COO at Centene's South Carolina health plan, Absolute Total Care, where he was responsible for a successful operational turn-around. He has been with Centene Corporation since 2012 when he served as vice president of health plan operations in St. Louis, Missouri. You will need Adobe Reader to open PDFs on this site. Background: Wilson joined MHS after serving as the CFO for MindGent Healthcare Services and Clinics, an information technology and healthcare company. Originally from Indianapolis, he graduated from Roncalli High School, and earned his Bachelor's degree from Ball State University and his Masters from Indiana Wesleyan University. He currently serves on the Board of Directors of Boy Scouts of America. Background: A self-employed, pediatrician for more than 30 years, Dr. Yancy continues to maintain his practice in Indianapolis. Originally from Baton Rouge, La., Dr. Yancy received his Bachelor degree from Southern University at Baton Rouge in Louisiana and his Doctor of Medicine from Creighton University Medical School with residency training at Indiana University Medical Center, Riley Hospital for TEENren. Dr. Yancy was the first African American pediatric resident at Riley hospital, starting in 1976, and is the 2011 recipient of the Creighton University School of Medicine Merit Award. Dr. Yancy serves on the board of Indiana Pediatrics, Inc. and the Joseph Maley Foundation. Background: Since August 2014, O'Toole has led MHS through tremendous growth and product expansion, procuring and implementing traditional Medicaid, Medicaid expansion, the Aged, Blind and Disabled program including foster care, a Federal Exchange Marketplace product and Medicare Advantage

4 products. Prior to moving to Indiana he served as the COO at Centene's South Carolina health plan, Absolute Total Care, where he was responsible for a successful operational turn-around. He has been with Centene Corporation since 2012 when he served as vice president of health plan operations in St. Louis, Missouri. Background: Claypool previously served as director of Medicaid risk for Indiana University Health Plans, which included P&L management for the Medicaid line of business. She also served as the director of Medicaid compliance for Anthem, overseeing compliance functions of 12 state Medicaid managed care contracts, and as the Director of Care Programs for Indiana FSSA. Originally from Warsaw, Indiana, Claypool received her Bachelor of Science in public policy from Indiana University and her Master of Public Affairs from Indiana University-Purdue University Indianapolis (IUPUI). She volunteers with Executive Women in HealthCare. Oversees: Member & Provider Services Customer Service Call Centers, local Claim Operations, customer communication and educational programs and Web portals functions. Oversees: Assistance with network providers and various MHS committees, with clinical care standards and medical practice policies, and promoting positive MHS relations with the local medical community. Prior to his roles with Centene Corporation, O'Toole spent 16 years with Medco and their predecessor companies acquired by Medco. He started as Division Controller in the Home Care business, and was promoted to Vice President of Finance and later to Vice President of Operations. There, he held roles overseeing the infusion pharmacy business in the central United States and had nationwide operational responsibility for the hemophilia specialty pharmacy operations in Nashville, TN. He also spent 6 years in healthcare consulting with Price Waterhouse and Ernst & Young in St. Louis. O'Toole received his Bachelor of Science in Microbiology, Master of Science in Public Health in Health Administration, and his Master of Business Administration in Finance from the University of Missouri-Columbia. He currently serves on the Board of Directors of Covering TEENs & Families. You will need Adobe Reader to open PDFs on this site. Oversees: Enrollment, invoicing, HIP program compliance, other aspects of HIP operations. Background: Daniel Rich came to MHS from Louisiana Healthcare Connections, another Centene plan, where he served as the Senior Director of Operations. He also brings experience as the Corporate Operations Manager for Centene Corporate, among other roles. Originally from St. Louis, Missouri, Rich received his Bachelor of Arts from Dartmouth College. He received his law degree from University of Missouri-Columbia Law School and his Master of Business Administration from Olin Business School at Washington University in St. Louis. Oversees: Quality Improvement, Pharmacy, Grievances & Appeals, Medical Directors and advisors, Clinical and Service QI Committee Chair, and NCQA accreditation and certification. Oversees: Marketing, Communications, Community and Member Outreach, Public Website and Portal Administration, Centralized Training, Oversight of Brand Strategy, Message Development and Execution, and Public Relations. Background: Dr. Baker joined MHS after serving as chief medical officer at Unison health plans in Greenville, DE, and Pittsburgh, PA. Originally from Margate, NJ, Dr. Baker earned a bachelor's degree at Pennsylvania State University and is a graduate of the Thomas Jefferson University's Jefferson Medical School. He earned an additional masters degree from Carnegie Mellon University in Dr. Baker serves on the Board of Directors of Fathers and Families. Oversees: Utilization Management, Referrals and prior Authorization Call Centers, Disease and Case Management. Background: Carlin previously served as senior director of marketing and communications. Prior to MHS, she was in the music and entertainment industry with Live Nation and Live-360. Jo received her Bachelor of Science in Journalism and Political Science from Ball State University. She serves as Secretary of the Board of Directors for Project Home Indy and Chair of the Women's Cabinet for the American Lung Association. Background: Since joining MHS in 2005, Shearer has held the titles of Manager and Director of Member Services and Provider Services. Previously, she worked as

5 Customer Service Director at Maxicare Indiana, a benefit advocate manager at what's known today as AmeriChoice (an enrollment broker) and was one of the first Benefit Advocates at the inception of the Hoosier Healthwise program. Originally from Centerville, IN, Shearer earned her Bachelor's degree at Franklin College. You will need Adobe Reader to open PDFs on this site. Oversees: Compliance with MHS' state contract and government affairs programs, Grievance & Appeals, Chief Compliance Officer. Background: Wilson joined MHS after serving as the CFO for MindGent Healthcare Services and Clinics, an information technology and healthcare company. Originally from Indianapolis, he graduated from Roncalli High School, and earned his Bachelor's degree from Ball State University and his Masters from Indiana Wesleyan University. He currently serves on the Board of Directors of Boy Scouts of America. Background: Barth serves as the Chief Operating Officer of Managed Health Services (MHS), a health plan serving over 260,000 Hoosiers. Barth joined MHS from the Center for Health Care Strategies in Princeton, NJ, where he was Senior Program Officer focused on the development and testing of Medicaid models that combined the financing, delivery, and administration of health services. Prior, he was Managed Care Director for the State of Indiana's Office of Medicaid Policy and Planning, where he oversaw programs serving both the TANF and Aged, Blind, and Disabled populations. Barth holds a Master's in Social Work from the University of Michigan and serves on the Board of Advisors for Indy Reads. Oversees: MHS operations for marketing, provider relations, contracting, provider data management, credentialing, member and provider call centers, and claims. Background: Ms. Hage has over a decade of experience in state and federal government and the private sector with a focus on public policy, communications and government affairs. Most recently, she was Vice President of Public Policy for United Way of Central Indiana where she led the federal, state and local engagement and policy efforts. She also served as Legislative and Senior Policy Director for the Family and Social Services Administration where she oversaw legislation, policy, administrative rulemaking and communications. Prior to serving in state government, Hage served in several policy, lobbying and communications positions in Washington D.C., including on Capitol Hill, lobbying for the State of Indiana and IU Health and spokeswoman for the Office of the U.S. Trade Representative. Hage holds a bachelor of arts in international marketing and economics from Taylor University. She is a graduate of the Richard G. Lugar Excellence in Public Service Series and is a member of the Women's Fund of Central Indiana OPTIONS Class 16. Background: Prior to working at MHS, Petrie served in several leadership roles for WellCare Health Plans, including senior director of program compliance, leading the company's compliance oversight, market liaison and analytics programs. He also has unique expertise as a regulator having overseen compliance for all Medicaid managed care plans for the state of Florida's Agency for Health Care Administration as well as implementation of new programs and policies. Originally from New York and having lived in Tampa, Fla., Petrie received his Bachelor of Arts in political science with a minor in psychology from Emory University in Atlanta, Ga. He is a member of the Health Care Compliance Association, and is a dedicated volunteer for Pop Warner, Special Olympics, Metropolitan Ministries and The Family Café.