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Case Manager I

Centene Corporation Type Full time Posted 6/27/2014
Salary - n/a - Starts - n/a -
MA - Massachusetts (All) - Waltham Referral 1001424    

Case Manager I (Prior Authorization) - 1001424

Description
Position Purpose: Review requests for contract specific prior authorization of services within a centralized unit

  • Review provider request for contract specific prior authorization through fax or telephone with application of evidence based criteria to ensure medical necessity for services
  • Act as clinical resource to unit referral specialist staff and make appropriate referrals
  • Provide provider education as directed
  • Data entry and inquiry using both claims and clinical system software for performance of the authorization review process with documentation into the appropriate systems

 

Qualifications
 
Education/Experience: At least two years clinical nursing experience. Utilization review, prior authorization, or managed care experience preferred.

Licenses/Certifications: Current RN, LPN or LVN license required. Utilization Management (CPUR) certification, Certified Case Manager (CCM), or equivalent preferred.

Job: Clinical & Nursing

Primary Location: USA-Massachusetts-Waltham

Organization: Health Plans

Schedule: Full-time