Authorization Management Clinical Reviewer

Job Description: • Review acute and post-acute authorizations for medical necessity using InterQual guidelines • Collaborate with case managers, physicians, and medical directors to ensure appropriate levels of care • Participate in team meetings, educational activities, and interrater reliability testing to maintain review consistency and professional growth • Ensure compliance with federal, state, and accreditation standards, and identify opportunities to enhance communication or processes • Utilize knowledge of resources available in the healthcare system to assist physicians and patients effectively • Perform other job duties as assigned Requirements: • Bachelor's Degree or equivalent work experience • Active RN License • At least 4-6 years relevant work experience • 2 years clinical acute nursing experience • 1-2 years' of hospital-based utilization management experience • Denials and Appeals experience (preferred) • Experience with managed care and CMS standards (preferred) • UM/CM Knowledge of ICD / CPT / DRG’s (preferred) • Proficient in the use of window-based computer programs (preferred) • Excellent verbal, written, and interpersonal communication skills • Critical thinking skills, creative problem solving, and proficient organization and planning skills Benefits: • Excellent medical, dental, and vision benefits • Mental health benefits through TelaDoc • Prescription drug coverage • Generous paid time off, plus 13 paid holidays • Paid parental leave • 100% vested 401(K) retirement plans • Educational assistance up to $2500 per year Apply tot his job Apply To this Job