Authorization Management Clinical Reviewer

Job description

As an Authorization Management Clinical Reviewer , you’ll play a vital role in ensuring patients receive the right care at the right time. Your primary responsibility will be reviewing acute and post-acute authorizations before submission to the payer and verify medical necessity is met using InterQual guidelines. In this role, you’ll collaborate with physicians, healthcare providers, and both internal and external stakeholders to support improved health outcomes. By following InterQual guidelines, you will ensure care is medically appropriate, high-quality, and cost-effective throughout the medical management process. What we’re looking for: Strong acute-care clinical background with the ability to apply evidence-based guidelines. Proficiency with technology solutions, including Microsoft Office and utilization management support tools, familiarity with CarePort Care Management preferred. Licensed RN, with the ability to obtain other clinical state licensures, as needed. Program business hours: 8:00a – 8:00p (staggered shifts) eastern time on weekdays, 8:00a – 4:00p on Saturdays, and 12:00p – 4:00p on Sundays, Shifts are 4 10hour shifts with weekend 1:4 rotation, flexibility to co...