RN Case Manager (Prior Authorizations)

Position Purpose:

• 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.

ABOUT THE POSITION:

• Review inpatient admissions to assure appropriate level of care and medical necessity for Sunshine State members.
• 100% Onsite/Telephonic

• RN REQUIRED
• Least 2 years of UM experience, must have at least one year of authorization experience
• Experience utilizing medical management software programs. Interqual/Miilman
  
• UM certification PREFERRED
• CCR PREFERRED

Shift: Mon-Fri 8:00A-5:00P

Salary: $62,000 - $72,000 + 6% Annual Bonus