Job Summary
A health care provider is filling a position for a Remote Pennsylvania Licensed Authorization Registered Nurse.
Individual must be able to fulfill the following responsibilities:
- Ensure clinical review process is followed in order to meet payor deadlines
- Serve as a liaison between care managers and payors and facilitates payor/physician contact when indicated
- Identify and assigns a root cause to each case to ensure denial reasons are tracked
Skills and Requirements Include:
- RN required
- Five years of acute care clinical experience, two years payer or care management experience
- Licensed in the State of Pennsylvania
- Prior utilization review experience
- Understanding of clinical and care management process Knowledge of medical necessity criteria
- Ability to apply InterQual criteria appropriately