RN Case Manager (Prior Authorizations)

Company Description

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Job Description

- 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

Qualifications

- RN required

- Need minimum of 2 years experience as an RN

- Need Prior Auths experience!

- Interqual exp A+, but will take Milliman or another similar system (if they haven’t used these systems, what have they used?)

- Knowledge of Medicaid/Medicare benefits

Education/Experience:

· 2+ years clinical nursing experience.

· Experience utilizing medical management software programs.

- License/Certification: RN license. Current state nursing license.

Additional Information

Advantages of this Opportunity:

• Pay $29.00 per hour
• Start Date: 7/06
• Contract 3 - 6 mos with possible conversion to perm role

If you are interested, please call, Cherry 407-233-0769 and email your resume to me.

The greatest compliment to our business is a referral.

If you know of someone looking for a new opportunity, please pass along my contact information! We offer referral bonuses of up to $100.00 for each placement.