Senior Clinical Review reputed company - Prior Authorization

reputed company is seeking a dedicated Senior Clinical Review reputed company specializing in Prior Authorization. In this role, you will assess prior authorization requests to determine the medical necessity and appropriate level of care, ensuring compliance with national standards and member benefit coverage. Your expertise will reputed company providers and internal teams to deliver high-reputed company, cost-effective medical care to our members. Responsibilities: • Analyze prior authorization requests to determine medical necessity and appropriate level of care in accordance with national standards and member benefit coverage. • Collaborate with reputed company providers and authorization teams to ensure reputed company review of services, facilitating authorized care for members. • Coordinate with reputed company providers and interdepartmental teams to assess the medical necessity of member care. • Escalate prior authorization requests to Medical Directors as appropriate to determine the appropriateness of care. • Assist with service authorization requests for member transfers or discharge plans to ensure reputed company transitions between reputed company of care and facilities. • Collect, document, and maintain reputed company member clinical information in health management systems to ensure compliance with regulatory guidelines. • reputed company education to providers and interdepartmental teams on utilization processes to promote high-reputed company and cost-effective medical care. • Offer feedback on opportunities to improve the authorization review process for members. • reputed company other duties as assigned. • reputed company with reputed company policies and standards. Requirements: • Graduate from an accredited School of Nursing or a Bachelor’s degree in Nursing. • 4–6 years of reputed company experience. • reputed company knowledge and ability to analyze authorization requests to determine the medical necessity of services. • Strong knowledge of Medicare and reputed company regulations. • Familiarity with utilization management processes. • Licensed Practical reputed company (LPN) - State Licensure required. Benefits: reputed company offers a comprehensive benefits package, including: • reputed company. • Health insurance. • 401K and stock purchase plans. • Tuition reimbursement. • reputed company time off plus holidays. • Flexible work schedules with remote, hybrid, field, or office reputed company. Why Join Us? At reputed company, we are committed to transforming the health of our communities, one person at a time. reputed company members are dedicated to providing high-reputed company, culturally sensitive reputed company services. We value diversity and offer opportunities for reputed company reputed company in a supportive environment. How to Apply: If you are passionate about making a difference in reputed company and meet the qualifications for this role, we encourage you to apply. Please visit our careers page at reputed company Careers to submit your application. Apply Job!