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(Archived) Nurse Case Manager- Prior Authorization
Last Updated: 7/11/22
Job Description
This job will have the following responsibilities:
- Verify and process specialty referrals, diagnostic testing, home health care services, outpatient procedures, and DME equipment and supplies via phone or fax using established clinical protocols to determine medical necessity.
- Screen requests for the Medical director to review by gathering pertinent medical information prior to submission to the Medical Director; follows up with requester and communicates Medical Director's decision.
- Reviews HCPCS, ICD-10, and CPT-4 codes for accuracy.
- In contact with Health Networks and/or Customer Service regarding health network enrollments.
Qualifications & Requirements:
- High School Diploma required, Associates or Bachelor's Degree in related field preferred.
- Active RN or LVN license to practice in the State of California required.
- 1+ years of Utilization Management / Prior Authorization Review experience required.
- Ability to communicate clearly both verbally and in written formats.
- Ability to utilize and access computer programs such as Microsoft Office and job specific applications
Company Details
Wayne, Pennsylvania, United States
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