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