RN Case Manager (Prior Authorizations)

- Review requests for prior authorization of medical services such as surgeries, pain management, home health care

· Review provider requests through fax or telephone to ensure medical necessity for services requiring preauthorization

· Utilize nationally recognized criteria to determine medical necessity of services requested

· Refer provider requests appropriately to Medical Director when medical necessity of services is not met based on the criteria

· Act as a clinical resource to referral staff

· Act as a liaison between the Provider and the Medical Director

· Data enters authorizations into the system

- RN required

- Need minimum of 2 years experience as an RN

- Need Prior Auths experience!

- Interqual exp A+, but will take Milliman or another similar system (if they haven’t used these systems, what have they used?)

- Knowledge of Medicaid/Medicare benefits

Education/Experience:

· 2+ years clinical nursing experience.

· Experience utilizing medical management software programs.

- License/Certification: RN license. Current state nursing license.

Advantages of this Opportunity:

• Pay $29.00 per hour
• Start Date: 7/06
• Contract 3 - 6 mos with possible conversion to perm role

If you are interested, please call, Cherry 407-233-0769 and email your resume to me.

The greatest compliment to our business is a referral.

If you know of someone looking for a new opportunity, please pass along my contact information! We offer referral bonuses of up to $100.00 for each placement.