RN Case Manager - Prior Authorization

Position Purpose: Review requests for contract specific prior authorization of services within a centralized unit

• Review provider request for contract specific prior authorization through fax or telephone with application of evidence based criteria to ensure medical necessity for services

• Act as clinical resource to unit referral specialist staff and make appropriate referrals

• Provide provider education as directed

•  Data entry and inquiry using both claims and clinical system software for performance of the authorization review process with documentation into the appropriate systems