Remote Prior Authorization Coordinator (LPN)

Community Health Network of Connecticut, Inc.; Wallingford (CT); Hybrid; USD 51.000 - 68.000; Vollzeit

Benefits dieser Stelle

Medical, dental, and vision coverage

FSAs/HSAs

Life insurance

401(k) with company match

Accidental injury coverage

Tuition reimbursement

Paid time off & holidays

Wellness program

Zusammenfassung

Community Health Network of Connecticut, Inc. (CHNCT) is seeking a Prior Authorization Coordinator in Wallingford, CT. The role involves medical necessity reviews and authorizations for CHNCT members, to ensure services align with benefit packages and clinical criteria.

Responsibilities include responding to provider requests, performing reviews for DME and procedures, and coordinating with a Medical Reviewer when needed. Eligible candidates possess an LPN license and related experience.

Qualifikationen

• Two years post-secondary schooling is desired.
• Associate's degree is preferred.
• Licensed practical nursing is the expected major.

Aufgaben

• Responds to telephonic and written requests by CHNCT providers for authorization and benefit coverage for CHNCT members.
• Conducts medical necessity review of requests for DME, outpatient therapies and prior authorizations for inpatient and outpatient procedures.
• Identifies need for coordination of benefits and identifies third party liability as appropriate.
• Utilizes the InterQual and/or Medicaid criteria to make decisions.
• Selects, formats, proofsreads and prints appropriate member and provider denial letters prior to mailing.
• Refers cases to CHNCT Medical Reviewer when clinical information does not support medical necessity.
• Assists in education of primary care providers, specialists and ancillary providers on CHNCT policies and procedures.

Ausbildung

Associate's degree

Jobbeschreibung

Community Health Network of Connecticut, Inc. (CHNCT) is seeking a Prior Authorization Coordinator in Wallingford, CT. The role involves medical necessity reviews and authorizations for CHNCT members, to ensure services align with benefit packages and clinical criteria.

Responsibilities include responding to provider requests, performing reviews for DME and procedures, and coordinating with a Medical Reviewer when needed. Eligible candidates possess an LPN license and related experience.