Prior Authorization Case Manager

Job Summary

A company is looking for a Case Manager for Prior Authorization in a remote position.

Key Responsibilities:

• Serve as a resource to the team, providing guidance on insurance issues and authorization submissions
• Review clinical documentation, coordinate with case managers, and submit surgery authorization requests
• Communicate with payers for status updates, assist with appeals, and educate on clinical documentation needed

Required Qualifications:

• Bachelor of Science or Vocational/Practical degree in Nursing (LVN-LPN) or Master's prepared Social Worker
• 5+ years of experience in coding, billing, prior authorization, and care coordination
• Familiarity with software such as Word, Excel, PowerPoint, Outlook, and One Note