Job Summary

A health services company is searching for a person to fill their position for a Telecommute Denials Prevention Specialist.

Individual must be able to fulfill the following responsibilities:

• Be responsible for providing timely referral/appeal determination by accurate use of care guidleines
• EngagepProper identification of eligibility and healthcare plans
• Work directly with the provider(s) and health plan Medical Director as needed to facilitate timely authorizations

Required Skills:

• Preferred Education: BA or BS in Nursing, experience preferred to preform
• Two (2) years managed care experience in UM/CM/CDI Department preferred
• 3 to 5 years acute care experience
• 2 years Health Plan or Acute Care UR/CM
• Experienced computer skills, Word, Excel, Outlook is ideal
• Experience working in a health plan medical management documentation system a plus