ABOUT OUR COMPANY
We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.


POSITION SUMMARY
Prior Authorization is the process of collecting information prior to inpatient admissions and performance of selected ambulatory procedures and services. The process permits advance eligibility verification, determination of coverage, and communication with the physician and/or member. It also allows Aetna Better Health to coordinate the member's transition from the inpatient setting to the next level of care or to refer patients for specialized programs such as Disease Management, Case Management, or our prenatal program. Prior Authorization may either be done telephonically or electronically.

ADDITIONAL JOB INFORMATION
Receive calls from providers regarding requested service/procedure, apply appropriate clinical criteria and make appropriate referrals to Medical Directors. Authorize and coordinate the requested service/procedure in accordance with the benefit plan
Application and/or interpretation of appropriate clinical criteria and guidelines, policies, procedures and regulatory standards while assessing Member's needs to ensure appropriate administration of benefits
Ensures accurate and complete documentation of required information is entered into designated systems.
Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
This position will be based in Philadelphia, PA after training and orientation to take place in the Blue Bell, PA offices.