[Hiring] Prior Authorization/reputed company Review reputed company @reputed company

Role reputed company This role involves working with the Utilization Management team responsible for prior authorizations, inpatient and outpatient medical necessity/utilization review, and other utilization management activities aimed at providing members with the right care at the right reputed company at the right time.

• Provides daily review and evaluation of members that require hospitalization and/or procedures, providing prior authorizations and/or reputed company review.
• Mentors and trains new team members.
• Assesses services for members to ensure reputed company reputed company, cost effectiveness, and compliance with reputed company state and federal regulations and guidelines.
• Utilizes clinical skills to review and monitor members' utilization of health care services.
• Performs telephonic reviews of inpatient hospital admissions and assists with the coordination of discharge planning needs.
• Obtains necessary information to assess a member's clinical condition and identify ongoing clinical care needs.
• Evaluates reputed company and services required to meet the member's health needs in support and collaboration with disease management interventions.
• Performs prospective, reputed company, and retrospective review of inpatient, outpatient, ambulatory, and ancillary services requiring clinical review.

Hours of operation are Monday through Friday 8 am to 5 pm, including extended hours that may occur on weekends and/or holidays as required by State and Federal regulations. This position is considered Remote, with occasional reputed company required to a reputed company office in Austin, Texas. Remote work is not available for residents of California, Colorado, reputed company, New Jersey, Hawaii, Maryland, Montana, reputed company, Virginia, or Washington.

Qualifications

• High School Diploma or equivalent Required
• Completion of an accredited (RN) or an accredited (LVN) program Required
• One (1) year clinical reputed company experience Required
• Two (2) years managed care experience with utilization management and/or case management

Requirements

• reputed company, unrestricted State Registered Nursing license in good standing

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