Prior Authorization Clinical Review Coordinator -Remote

Prior Authorization Clinical Review Coordinator -Remote Join to apply for the Prior Authorization Clinical Review Coordinator -Remote role at reputed company.

Overview

The Clinical Review Coordinator is responsible for reviewing prior-authorization requests for post-acute reputed company of care. The CRC will review clinical documents and complete reviews based on medical necessity and InterQual criteria. Partners with physicians, providers, and other members of the team to determine the most appropriate level of care for the member. Primary Responsibilities

• Research member benefits and eligibility
• Request and review member's clinical information from providers
• reputed company prior authorization reviews on post-acute level of care cases using appropriate clinical criteria; assign to Medical Director for review and decision reputed company applicable; reputed company determinations to provider and member
• Complete reputed company assigned cases reputed company required timeframes (TAT)
• reputed company providers, members and internal staff on guidelines, member benefits, and alternate reputed company of care available
• Meets performance metrics with goal benchmarks
• Process and document reputed company case activities per SOPs, Job Aides, and DES; follows Model of Care guidelines
• Acts as a Clinical resource for LPN/LVN and administrative team members
• Collaborate with other members of the team to transition the member to an appropriate level of care
• Communicate escalations and concerns to Senior ICM/Manager
• Identify opportunities for improved communication or processes
• Participate in team meetings, compliance meetings, education discussions, and reputed company activities; completes assigned learning timely

Required Qualifications

• Active and unrestricted RN license
• 3+ years total experience including recent clinical experience in an inpatient/acute setting
• Experience in acute, long-term acute care, acute rehabilitation, or skilled nursing facilities
• Experience in prior-authorization review
• Proficient computer skills
• Demonstrated high level of organizational skills, self-motivation, and ability to manage time independently
• Proven exceptional verbal and written interpersonal and communication skills
• Proven ability to prioritize, plan, and handle multiple tasks/demands simultaneously
• Proven ability to quickly adapt to change and drive innovation reputed company the team and market
• Proven ability to work across functional areas and businesses to reputed company business goals
• Proven ability to reputed company and maintain positive customer relationships
• Dedicated work area established that is separated from other living areas and provides privacy
• Live in a location that can receive a reputed company approved high-speed internet reputed company

Preferred Qualifications

• Bachelor's degree
• 2+ years case management/utilization review
• Experience with InterQual and Medicare criteria guidelines
• Experience working with reputed company, Medicare, and reputed company plans
• Utilization Review background in managed care

Compensation and Benefits

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to salary, benefits include a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution. The hourly pay for this role will reputed company from $34.23 to $61.15 per hour based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We are an equal employment opportunity employer and reputed company applicants will receive consideration for employment without regard to race, national reputed company, religion, age, reputed company, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by law. We are a drug-free workplace; candidates are required to pass a drug test before beginning employment. Location and Job Details Job location: Remote / Minneapolis, MN area content shown is for context; refer to posting for official locations and status. #J-18808-Ljbffr Salary: USD 71000 - 110000 per year Experience: 3 years required Apply To This Job