The Judge Group is looking for a skilled Care Review Clinician!!
•MUST have experience reviewing Prior Authorization requests
•Case Management experience does not qualify candidate for the position
•InterQual or Milliman experience is desired
•Business expectation is to review 60-65 Prior Authorization cases per day.
•Weekend and Holiday hours may be required
Required licensure (if applicable):
Active, unrestricted State Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) in good standing
Day to Day Responsibilities:
Will be responsible for prior authorizations, for outpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time.
Provides daily review and evaluation of members that require procedures requiring prior authorizations.
Assesses services for Molina Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
Licensed Vocational Nurses
Licensed Practical Nurse