US-TX-Dallas: Prior Authorization RN, TX licensed RN, Utilization Mgmnt, Medicai (45297732402)

US-TX-Dallas: Prior Authorization RN, TX licensed RN, Utilization Mgmnt, Medicai 
(45297732402)
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Position:     Prior Authorization RN
Reference:    SMC01363
Location:     Dallas TX
Duration:

Skills:       Ability to fully understand and apply concepts, practices
              and procedures related to field/area of work, typically
              acquired through an Associate¡¦s degree or 3-5 years of
              job-related experience.

              Specific experience/knowledge requirements:       
              TX State licensed RN with 3-5 years experience.
              Familiarity with utilization management principles, diagnosis,
              coding, Inerqual and Milliman & Roberts and healthcare management
              systems.
              Medicaid program experience.
              Organizational, communication and computer literate.


Scope:        Performs prior authorization. Reviews PA requests and
              approves according to established criteria and protocols.
              Maintains appropriate documentation and support for all
              requests.   Prepares documentation and support and presents
              potential denials to the Medical Director and
              develops/reviews denial letters.


Please send your current resume in confidence to <[EMAIL PROTECTED]>

.45297732402.