Remote Prior Authorization Coordinator – Medical Necessity

Community Health Network of Connecticut, Inc; Wallingford (CT); Remote; USD 51,000 - 68,000; Full time

Benefits offered by this job

Medical/Dental/Vision

FSAs/HSAs

Life insurance

401(k) with match

Tuition reimbursement

Paid leave & holidays

Wellness program

Job summary

Community Health Network of Connecticut, Inc. is seeking a Prior Authorization Coordinator in Wallingford, CT. The role focuses on medical necessity reviews, benefit determinations, and coordination of authorizations for CHNCT members.

You will engage with providers, utilize InterQual/Medicaid criteria, and prepare denial letters while supporting education of clinicians and staff. A licensed practical nurse with 3–5 years of experience is preferred.

Qualifications

• Two years post-secondary schooling as a base requirement.
• Active Licensed Practical Nurse License is required.
• 3 to 5 years of related experience in healthcare administration.

Responsibilities

• Responds to telephonic and written requests for authorization and coverage.
• Conducts medical necessity reviews for DME and procedures.
• Identifies coordination of benefits and third party liability as needed.
• Uses InterQual/Medicaid criteria to support decisions.
• Prints and proofreads denial letters and forwards appropriately.
• Educates providers on CHNCT policies and procedures.

Education

Associate's degree

Licensed practical nursing

3-5 years experience

Job description

Community Health Network of Connecticut, Inc. is seeking a Prior Authorization Coordinator in Wallingford, CT. The role focuses on medical necessity reviews, benefit determinations, and coordination of authorizations for CHNCT members.

You will engage with providers, utilize InterQual/Medicaid criteria, and prepare denial letters while supporting education of clinicians and staff. A licensed practical nurse with 3–5 years of experience is preferred.