RN Case Manager (Prior Authorizations)

- Review requests for prior authorization of medical services such as surgeries, pain management, home health care

· 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