This position, under the direction of the Manager of Prior Authorizations, is responsible for reviewing and processing requests for authorization and notification of medical services from health professionals, clinical facilities and ancillary providers. The incumbent is responsible for tasks/functions related to Company's prior authorization and referral process. The process includes actively participating in telephone on-line responsibilities as well as selected off-line tasks/functions. He/she is responsible for applying Company's medical criteria and policies/procedures to authorization or referral requests from medical professionals, clinical facilities and ancillary providers. He/she will directly interact with provider callers, acting as a resource for their needs.
RN or LVN, an understanding of current CPT-4, ICD-10 and HCPCS, experience with Utilization review,/Prior authorization. responsible for tasks/functions related to prior authorization and referral
Seeking candidates with excellent interpersonal skills, who are capable of working independently in a fast paced environment, who are able to meet deadlines, and possess excellent management skills. Below you will note a few of the requirements along with the rest of the details for this position.
" Current LVN/RN License to practice in the state of California
" Active CCM certification preferred
" Minimum of 3 years current clinical experience preferred
" Managed care experience preferred
" Knowledge of CPT/HCPCS and ICD 10-CM medical coding
" Excellent communication skills, organizational and time management skills
It is a full-time (40 hours) position, working Monday-Friday from 8am-5pm.
Job Type: Full-time
Schedule: Monday-Friday We are an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, sex, sexual orientation, age (40 and over), gender identity, national origin, protected veteran status, disability or any other protected classification under federal and state law.
Electronic Medical Record
Patient Care Coordination