RN Case Manager Prior Authorizations
Offer summary
Qualifications:
Registered Nurse (RN) license., Minimum of 2 years of utilization management experience, including at least 1 year of authorization experience., Experience with medical management software such as Interqual or Milliman., Preferred certifications include CCR and UM certification..Key responsibilities:
- Request prior authorization of durable medical equipment (DME) for members.
- Review provider requests via fax or telephone to assess medical necessity.
- Utilize recognized criteria to determine the medical necessity of services.
- Enter authorization data into the system.
Job description
Company Description
HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!
Job Description
Will be requesting prior authorization of durable medical equipment for members.
100% Telephonic
Requests for prior authorization of DME
Review provider requests through fax or telephone to ensure medical necessity for services requiring pre-authorization
Utilize nationally recognized criteria to determine medical necessity of services requested
Refer provider requests appropriately to Medical Director when medical necessity of services is not met based on the criteria
Data enters authorizations into the system
Qualifications
RN
At least 1 years of DME experience * Preferred
At least 2 years of UM experience, must have atleast one year of authorization experience
Plus to have CCR
Experience utilizing medical management software programs. Interqual/Miilman
UM certification preferred.
Managed Care preferred not required
Look for people who come from any type of DME facility, pharmacy...
Will send from from large providers office is have over two years of Prior Auths.
Additional Information
-Salary range 60K-72K
-Excellent opportunity to begin a career with one of Florida's leading health plans with excellent benefits
Required profile
Experience
Other Skills
- Teamwork
- Communication
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