Case Manager I (Prior-Authorization)

Company Name:
## 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

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