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Prior Authorization Nurse Job
Eingestellt von Yoh
Gesuchte Skills: Client
Projektbeschreibung
Top Skills Should You Possess:
- Previous case management or utilization management experience
- Knowledge of Medi-Cal
What You'll Be Doing:
- Ensure that prior authorization requests are completed in a timely fashion to meet contractual requirements and that all reviews are conducted using nationally recognized and evidence based standards
- Coordinate and follow the established preauthorization review process for outpatient and inpatient services
- Functioning as a resource for non-licensed staff in evaluating reviews for members with complex conditions
- Review both inpatient and outpatient authorization requests in an accurate, thorough and efficient manner
What You Need to Bring to the Table:
- Current California RN or LVN license
- A minimum of three (3) years of experience in a patient care setting
- A minimum of one (1) year of experience in utilization management, case management or an equivalent combination of education and experience
- Current working knowledge of Milliman Care Guidelines in review determination process
- Knowledge of Medi-Cal and related policy and Title 22 regulations
- Knowledge of utilization management principles and activities
- Knowledge of case management principles and activities
- Knowledge and understanding of concepts pertaining to prepaid health care
WHAT ARE YOU WAITING FOR? APPLY NOW!
RECRUITER: Jennifer Andersen
Yoh, a Day & Zimmermann company, is an Equal Opportunity Employer, M/F/D/V.
J2W: HC
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Ref:
SFSF: HC
Projektdetails
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Einsatzort:
Santa Cruz, 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