Location : Remote- Nationwide
SHIFT : mon - Fri 8am-5pm est / cst
Duration : 6+ months
Walk me through the day to day responsibilities of this the role and a description of the project :
Review clinical documentation and perform utilization management reviews for prior authorizations
Describe the performance expectations / metrics for this individual and their team :
When completely trained completing 20-22 authorizations per day at minimum
Job Description : Position Purpose :
Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage.
Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care.
Education / Experience :
Requires Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing and 2 - 4 years of related experience.
Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred.
Knowledge of Medicare and Medicaid regulations preferred.
Knowledge of utilization management processes preferred.
License / Certification :
LPN - Licensed Practical Nurse - State Licensure required / Required Skills / Experience : Preferred Skills / Experience : 1.
Nursing license in IL, IN, or NC preferred 1. 2. Critical thinking skills 2. 3. Quick to learn new computer programs 3. Education Requirement : Completion of an accredited Nursing program Education Preferred : Associates degree in Nursing / Bachelors degree in Nursing Software Skills Required : Microsoft and any clinical documentation system Required Certifications : Nursing lic. Required Testing :
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