RN Case Manager Prior Authorizations

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

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.

-Salary range 60K-72K

-Excellent opportunity to begin a career with one of Florida's leading health plans with excellent benefits