Clinical Project Manager / Prior Authorizations (LVN)

Job description

Position Summary: The Clinical Nurse Project Manager role will promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to denials. This role will review for appropriate care and setting, and follow guidelines/policies as they relate to the review process . This role will be responsible for processing denial letters for all affiliated groups, interpreting denial language provided by the prior authorization nurse, coordinators, and medical directors, and placing it into the appropriate templates while translating medical terminology into lay language and grading the reading level as appropriate. They will work closely with the coordinators in the department for clinical guidance on denial cases. Essential Duties and Responsibilities include the following: - Understand all aspects of the functionality of Access Express concerning prior authorization and the denials - Complete assigned tasks accurately and within specified time limits - Maintain smooth working relations with co-workers and supervisors, be a “Team Player” - Anticipate future events, set realistic goals, timetables, and coordinate a...