Learn More. The Peer-to-Peer request must be received by Maryland Amerigroup maryland prior authorization Care within two 2 business days of the initial notification of the denial. The intent of the Peer-to-Peer is to discuss the denial decision with the ordering clinician or attending physician. For specific details prioe authorization requirements, please refer to our Quick Reference Guide. Certain carefirst mental providers require prior authorization regardless of place of service.
These surgeries include but are not limited to:. Previous Page. Next Page. For those without a medical contraindication to hormonal therapy, the individual has undergone a minimum of 12 continuous months of hormonal therapy that was recommended by a mental health professional and supervised by a physician over the entire month period; and Documentation that the individual has completed a minimum of 12 months of successful continuous full-time, real-life experience in their desired gender, across a wide span of life experiences and events that may occur throughout the year i.
Mammoplasty: breast augmentation Facial Reconstruction: Other surgeries for assisting in body feminization or body masculinization are generally labeled cosmetic as they provide no significant improvement in physiologic function. Analysis is required to identify root cause. Uses judgment within defined boundaries to develop alternate solutions, both long and short term.
Level of Supervision Received Plans and arranges own work, refers only unusual cases to supervisors or others. Impact Failure to accomplish results can normally be overcome without significant effect on the organization. Part of a team who represents the organization.
Monitors activities and communicates information across the organization. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Basic understanding of health plan or health insurance operations e. NCQA or other regulatory familiarity. Knowledge, Skills and Abilities KSAs Proficiency Excellent intercultural communication and relationship management skills Advanced Extensive understanding of transgender community and community resources Expert Excellent verbal and written communication skills, along with the telephonic and keyboarding skills necessary to assess, coordinate and document services for members.
Proficient Knowledgeable of available community resources and programs. Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.
Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. The associate is primarily seated while performing the duties of the position.
Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. Build a Resume Find a job salary Jobs Login. Type: Full Time. Apply Now.
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