Clinical Authorization Specialist
Job Description
Company: PAM Health
Location: Enola, US
If you’re looking for a schedule that fits your lifestyle, check out PAM Health – and ask us about our comprehensive benefits package!
Some things that our hospital can offer YOU as a full-time employee:
• Medical Benefits: EPO/HDHP/HSA options, including prescription coverage, Rx ’n Go, and Teladoc
• Comprehensive dental and vision benefits
• Employee Assistance Program, including counseling, legal, and financial service
• Flexible spending (FSA) and health savings (HSA) accounts
• Life and Disability insurance benefits
• Education/In-Service Opportunities including continuing education and tuition assistance
• Supplemental benefits: Accident, critical illness, cancer, pet, and identity theft protection insurance options
• Auto, Home, Cell Phone, and Gym Membership discount offerings
• Personal Travel Discounts
• Employee Bonus Referral Program
• 401(k) plans and discretionary employer match
• Generous Paid Benefit Time
The Clinical Authorization Specialist is responsible for managing Commercial and Medicare Advantage admission authorizations by conducting a comprehensive analytic review of clinical documentation to determine if a patient is clinically appropriate for admission and the best course of action to obtain authorization from the payer. The Clinical Authorization Specialist will write sound, compelling, factual argument for the purpose of admission and/or to overturn a denial received from a payor for admission.
• Education and Training: Bachelors or Associates degree in nursing preferred.
• Knowledge in the area of LTAC and IRF Criteria including: Medicare, InterQual and Milliman are preferred.
• Currently licensed as an RN, preferred.
• Experience: Five years (5) experience as a clinical nurse in an acute care setting. In addition, having at least two years of experience in appeals, case management, discharge planning and/or utilization review is preferred.
Source: LinkedIn
