Clinical Authorization Specialist

PAM Health Corp Business Office•Plano, TX

23h•Remote

About The Position

The Clinical Authorization Specialist is responsible for managing Commercial and Medicare Advantage admission authorizations by conducting a comprehensive analytic review of clinical documentation to determine if a patient is clinically appropriate for admission and the best course of action to obtain authorization from the payer. The Clinical Authorization Specialist will write sound, compelling, factual argument for the purpose of admission and/or to overturn a denial received from a payor for admission.

Requirements

Bachelors or Associates degree in nursing preferred.
Knowledge in the area of LTAC and IRF Criteria including: Medicare, InterQual and Milliman are preferred.
Currently licensed as an RN, preferred.
Five years (5) experience as a clinical nurse in an acute care setting.
In addition, having at least two years of experience in appeals, case management, discharge planning and/or utilization review is preferred.

Responsibilities

The Clinical Authorization Specialist is responsible for managing Commercial and Medicare Advantage admission authorizations by conducting a comprehensive analytic review of clinical documentation to determine if a patient is clinically appropriate for admission and the best course of action to obtain authorization from the payer.
The Clinical Authorization Specialist will write sound, compelling, factual argument for the purpose of admission and/or to overturn a denial received from a payor for admission.

Benefits

Medical Benefits: EPO/HDHP/HSA options, including prescription coverage, Rx ’n Go, and Teladoc
Comprehensive dental and vision benefits
Employee Assistance Program, including counseling, legal, and financial service
Flexible spending (FSA) and health savings (HSA) accounts
Life and Disability insurance benefits
Education/In-Service Opportunities including continuing education and tuition assistance
Supplemental benefits: Accident, critical illness, cancer, pet, and identity theft protection insurance options
Auto, Home, Cell Phone, and Gym Membership discount offerings
Personal Travel Discounts
Employee Bonus Referral Program
401(k) plans and discretionary employer match
Generous Paid Benefit Time