About the position
Responsibilities
• Performs pre-service authorization reviews to obtain payment authorization for both inpatient and outpatient services.
• Succinctly abstracts fact based clinical information to support pre-authorization utilizing applicable nationally recognized and payer-specific criteria.
• Communicates timely the clinical information supporting the medical necessity of an ordered test/treatment/procedure/surgery as applicable to the patient's health plan and documents the outcome of the task.
• Participates in quality control audit process and department projects to improve overall Conifer and client scorecard metrics.
• Provides feedback regarding improvement opportunities for workflow &/or procedures.
• Demonstrates proficiency in the use of multiple electronic tools required by both Conifer and its clients.
• Collaborates with and engages internal and external customers in opportunities for prevention of future disputes.
• Identifies potential process gaps and recommends sound solutions to CAS leadership.
• Performs other duties as assigned.
Requirements
• Must possess a valid nursing license (Registered or Practical/Vocational). LPN or RN PREFERRED.
• Minimum of 3-5 years as a pre-authorization or utilization review nurse in a payer or acute care setting; preferably medical-surgical or critical care/ED.
• Ability to work independently and self-regulate in compliance with deadlines.
• Proficiency in the application of applicable nationally and payer authorization criteria.
• Possesses excellent customer service skills that include written and verbal communication.
• Minimum Intermediate Microsoft Office (Excel and Word) skill.
• Ability to critically think, problem solve and make independent decisions.
• Ability to interact intelligently and professionally with other clinical and non-clinical partners.
• Ability to prioritize and manage multiple tasks with efficiency.
• Advanced conflict resolution skills.
• Ability to communicate effectively at all levels.
• Ability to conduct research regarding payer pre-authorization guidelines and applicable regulatory processes related to the pre-authorization process.
Nice-to-haves
• Certified Professional in Utilization Review/Utilization Management/Healthcare Management (CPUR, CPUM, or CPHM) or Certified Case Manager (CCM) preferred.
Benefits
• Medical, dental, vision, disability, and life insurance.
• Paid time off (vacation & sick leave) - min of 12 days per year, accrue at a rate of approximately 1.84 hours per 40 hours worked.
• 401k with up to 6% employer match.
• 10 paid holidays per year.
• Health savings accounts, healthcare & dependent flexible spending accounts.
• Employee Assistance program, Employee discount program.
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
• For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act.
Apply Now
Apply Now