RN Case Manager - Prior Authorization
Posted Updated 3
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Description
Position Purpose: Review requests for contract specific prior authorization of services within a centralized unit
- Review provider request for contract specific prior authorization through fax or telephone with application of evidence based criteria to ensure medical necessity for services
- Act as clinical resource to unit referral specialist staff and make appropriate referrals
- Provide provider education as directed
- Data entry and inquiry using both claims and clinical system software for performance of the authorization review process with documentation into the appropriate systems
Education/Experience: At least two years clinical nursing experience. Utilization review, prior authorization, or managed care experience preferred.
- Active OH RN Licensure
- Experienced with either Interqual or Milliman
Licenses/Certifications: Current RN, required. Utilization Management (CPUR) certification, Certified Case Manager (CCM), or equivalent preferred.
Advantages of this Opportunity:
• Hours for this Position: Monday- Friday 8a-5p
• Pay $30.00 per hour
• Start date: 7/6
If you are interested, please call, Lovely 321-574-6539 and email your resume to me.
The greatest compliment to our business is a referral.
If you know of someone looking for a new opportunity, please pass along my contact information! We offer referral bonuses of up to $100.00 for each placement.