RN Case Manager Prior Authorizations
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
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