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Pre-Certification Nurse Job
Eingestellt von Yoh
Gesuchte Skills: Cms, Client
Projektbeschreibung
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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Projektdetails
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Einsatzort:
Oakland, Vereinigte Staaten
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Projektbeginn:
asap
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Projektdauer:
Keine Angabe
- Vertragsart:
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Berufserfahrung:
Keine Angabe
Geforderte Qualifikationen
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Kategorie:
IT Entwicklung, Webentwicklung