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Pre-Certification Nurse Job

Eingestellt von Yoh

Gesuchte Skills: Cms, Client

Projektbeschreibung

PRE-CERTIFICATION NURSE needed for a CONTRACT opportunity with Yoh's client located in Oakland, CA.

THE BIG PICTURE - TOP SKILLS YOU SHOULD POSSESS:

- Pre-certification experience
- Previous work history in health plan or IPA setting

WHAT YOU'LL BE DOING:

- Review provider requests for prior authorization of outpatient and inpatient services for commercial and Medicare product lines
- Conduct prospective and retrospective authorization review for up to 50 cases per day
- Ensure services authorized are covered benefits and medically necessary
- Forward potential denials and services requiring physician review to the assigned medical director

WHAT YOU NEED TO BRING TO THE TABLE:

- Current California RN or LVN license
- Strong working knowledge of clinical criteria sets such as CMS local and national guidelines, Milliman criteria, and Interqual criteria
- Minimum five (5) years experience in a medical setting
- Prior pre-certification experience required
- Experience working with health plans, IPAs, physician offices, ancillary vendors and hospitals
- Ability to read and interpret health plan contracts/DOFRs, medical policy guidelines

WHAT ARE YOU WAITING FOR? APPLY NOW!

RECRUITER: Jennifer Andersen

Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer, M/F/D/V. Contact us if you are an individual with a disability and require accommodation in the application process.

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Ref:

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Projektdetails

  • Vertragsart:

    Contract

  • Berufserfahrung:

    Keine Angabe

Geforderte Qualifikationen

  • Kategorie:

    IT Entwicklung, Webentwicklung

  • Skills:

    cms, client

Yoh