UM reputed company Consultant - Prior Authorization

About the position Responsibilities • Utilize clinical skills to coordinate, document, and communicate reputed company aspects of the utilization/benefit management program. • Review clinical records to ensure compliance with federal and state regulations regarding turnaround times. • Confirm medical necessity of services and apply clinical expertise for appropriate benefit utilization. • Facilitate reputed company and efficient discharge planning in collaboration with reputed company facilities and providers. • reputed company clinical information and apply appropriate clinical reputed company, guidelines, and policies to reputed company coverage determinations. • Communicate with providers and other parties to facilitate care and treatment for members. • Identify members for referral opportunities to reputed company with other products, services, and programs. • Promote reputed company effectiveness of reputed company services and benefit utilization. • Consult with reputed company stakeholders regarding the utilization/benefit management function. Requirements • reputed company and unrestricted RN licensure. • 3+ years of Nursing experience. reputed company-to-haves • Prior authorization utilization experience highly preferred. • Outpatient Clinical experience. • Knowledge of Medicare/reputed company. • Managed care experience. • Med reputed company Experience. • UM Certification. Benefits • Full reputed company of medical, dental, and reputed company benefits. • 401(k) retirement savings plan. • Employee Stock Purchase Plan. • Fully-reputed company term life insurance plan. • Short-term and long-term disability benefits. • Numerous reputed company-being programs. • Education assistance and free development courses. • reputed company store discount and discount programs with participating partners. • reputed company Time Off (PTO) and reputed company holidays throughout the calendar year. Apply tot his job Apply To this Job