Offer summary
Qualifications:
Minimum Three (3) years of UM referral review experience in a managed care setting., Understanding of criteria set by company like Milliman or InterQual., High School Diploma or GED., Current RN or LVN license (unrestricted)..
Key responsabilities:
- Review referrals for approval, modification or denial.
- Ensure timely completion and documentation.
- Identify out-of-area providers and non-covered benefits.
- Provide education to providers regarding benefits.
- Assist with claims review and referrals appropriately.