Clinical Pre-Authorization Specialist

Baton Rouge General Medical Center; Baton Rouge (LA); On-site; USD 65,000 - 85,000; Full time

Job summary

Baton Rouge General Medical Center is seeking an experienced Utilization Management professional to optimize clinical and financial resources, ensuring medical necessity and proper documentation for scheduled procedures. The role involves coordination with admission, precertification, and payer teams to secure timely authorizations and minimize denials.

The position requires nursing experience and familiarity with InterQual/MCG criteria, ICD-9/10 coding knowledge, and strong analytical and

Qualifications

• Required – 2 Years Nursing Experience
• Preferred – 2 years clinical experience in case management
• Required – High School Diploma or GED
• Required - Knowledge of ICD-9/10 coding and InterQual/MCG Criteria

Responsibilities

• Coordinate utilization of clinical and financial resources for procedures.
• Ensure physician documentation supports medical necessity and payer prereqs.
• Perform admission reviews for appropriateness of level of care.
• Collaborate with Care Coordinators to avoid denials and improve reimbursement.
• Document and communicate with payers and hospital staff.

Skills

Nursing experience

Analytical skills

Communication

Education

High School Diploma or GED

Tools

InterQual/MCG Criteria

Job description

Baton Rouge General Medical Center is seeking an experienced Utilization Management professional to optimize clinical and financial resources, ensuring medical necessity and proper documentation for scheduled procedures. The role involves coordination with admission, precertification, and payer teams to secure timely authorizations and minimize denials.

The position requires nursing experience and familiarity with InterQual/MCG criteria, ICD-9/10 coding knowledge, and strong analytical and