Remote Prior Authorization Clinician II (RN/LVN)

Lancesoft; Long Beach (CA); À distance; USD 63 000 - 65 000; Plein temps

Avantages offerts par ce poste

Medical Insurance—4 options

Dental Insurance

Vision Insurance

401k Contributions

Critical Illness Insurance

Voluntary Life Insurance

Accident Insurance

Résumé du poste

LanceSoft is seeking a Healthcare - Care Review Clinician II for a remote role in the United States. The position involves medical necessity reviews and prior authorization work for outpatient services, with training and after-training Saturday shifts.

Requirements include 3+ years in health plan or IPA prior authorization and a CA RN or LVN license. Travel to client offices or hospitals may be required as state plans vary.

Qualifications

• 3+ years experience in Health Plan or IPA performing prior authorization review for OUTPATIENT.
• CA RN OR LVN license.

Responsabilités

• Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.
• Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
• Identifies appropriate benefits and eligibility for requested treatments and/or procedures.
• Conducts prior authorization reviews to determine financial responsibility for client Healthcare and its members.
• Processes requests within required timelines.
• Refers appropriate prior authorization requests to Medical Directors.
• Requests additional information from members or providers in consistent and efficient manner.
• Makes appropriate referrals to other clinical programs.
• Collaborates with multidisciplinary teams to promote client Care Model
• Adheres to UM policies and procedures.

Connaissances

Prior authorization

Formation

CA RN or LVN license

Description du poste

LanceSoft is seeking a Healthcare - Care Review Clinician II for a remote role in the United States. The position involves medical necessity reviews and prior authorization work for outpatient services, with training and after-training Saturday shifts.

Requirements include 3+ years in health plan or IPA prior authorization and a CA RN or LVN license. Travel to client offices or hospitals may be required as state plans vary.