RN Case Manager (Prior Authorizations)

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Position Purpose:

• Review provider requests through fax or telephone to ensure medical necessity for services requiring pre-authorization
• Utilize nationally recognized criteria to determine medical necessity of services requested
• Refer provider requests appropriately to Medical Director when medical necessity of services is not met based on the criteria
• Data enters authorizations into the system.

ABOUT THE POSITION:

• Review inpatient admissions to assure appropriate level of care and medical necessity for Sunshine State members.
• 100% Onsite/Telephonic

Qualifications

• RN REQUIRED
• Least 2 years of UM experience, must have at least one year of authorization experience
• Experience utilizing medical management software programs. Interqual/Miilman
  
• UM certification PREFERRED
• CCR PREFERRED

Additional Information

Shift: Mon-Fri 8:00A-5:00P

Salary: $62,000 - $72,000 + 6% Annual Bonus