RN Case Manager (Prior Authorizations)

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