[Close] 

Case Manager I (Prior-Authorization)

Company Name:
Centene
## Description
Position Purpose: Review requests for prior authorization of medical services such as surgeries, pain management, home health care.
Position Responsibilities:
Review provider requests through fax or telephone to ensure medical necessity for services requiring preauthorization.
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.
Act as a clinical resource to referral staff
Act as a liaison between the Provider and the Medical Director
Data enters authorizations into the system.
## Qualifications
Knowledge/Experience: At least two years clinical nursing experience. Experience utilizing medical management software programs.
Licenses/Certifications: RN, LPN or LVN required. Current state nursing license.
## Job
Job: Clinical & Nursing
Primary Location: USA-Georgia-Smyrna
Other Locations: USA-Centene-Centene
Organization: Peach State Health Plan
Schedule: Full-time
Req ID: 006S6

Don't Be Fooled

The fraudster will send a check to the victim who has accepted a job. The check can be for multiple reasons such as signing bonus, supplies, etc. The victim will be instructed to deposit the check and use the money for any of these reasons and then instructed to send the remaining funds to the fraudster. The check will bounce and the victim is left responsible.

More Jobs

Telecommuting Complex RN Case Manager
Atlanta, GA Vibra Healthcare
Remote Stage I HCFC Phase-Out Management Plan ...
Atlanta, GA United Nations Development Programme (UNDP)
Principal Product Manager - Buyer Solutions
Atlanta, GA Cox Automotive
Telecommuting Pharmacy Business Change Manager
Atlanta, GA Anthem, Inc.
Telecommuting Special Insurance Investigations...
Atlanta, GA Humana
Telecommuting Healthcare Enterprise Senior Rel...
Atlanta, GA U.S. Bank (U.S. Bancorp)