Clinical Review Nurse - Prior Authorization (Hospice)
Company: Home State Health Plan | Location: Remote, United States | Employment: Full-time | License: LPN/LVN | State licensure: Alabama|Arkansas|Florida|Iowa|Kansas|Kentucky|Missouri|New Jersey|Ohio
Position Purpose: Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage. Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care. Key Details: Applicants for this role have the flexibility to work remotely from their home anywhere within the United States. Full-time, Monday through Friday, 8:00 a.m. to 5:00 p.m. in the employee's local time zone. Weekend coverage is required approximately once every six weeks (Saturday and Sunday), and rotating holidays with flexible scheduling provided during the week to accommodate weekend hours worked. • Performs medical necessity and clinic