Prior Authorization Nurse (LVN)

Job description

Position Summary: The Case Manager Prior Authorization LVN is responsible for supporting the process that manages all outpatient services, including other Prior Authorization Nurses .The goal of the Lead is to actively participate in regular monitoring, auditing and mentoring PANs productivity and clinical reviews. Ensuring that the PAN is following the guidelines in the approval of services or making recommendations for other determinations to the provider/vendor (denial/modification/redirection). Additionally, the goal of the Lead is to model for the PANs proper process and procedure as well as cooperation and support to the other PANs, physician reviewers, Supervisor(s)/Managers(s), and Medical Directors by knowing the process, and working to deliver excellent care based on medical management referral processing guidelines. Essential Duties and Responsibilities include the following: - Understand, promote and audit the principles of M. to facilitate the right care at the right time in the right setting. - Communicate effectively and interact with the provider group, staff and health plans daily or as indicated regarding PA and referral authorization issues. - Identify and handle...