Pre-Authorization Coord - RN/LPN Job position at Coventry Health Care in South Jordan

Coventry Health Care is currently interviewing Pre-Authorization Coord - RN/LPN Job on Wed, 30 Oct 2013 00:06:33 GMT. Description: It's a great time to put the strength of Coventry Health Care behind your career! Coventry is currently recruiting for projected openings in our Utah health plan, Altius, related to our anticipated entrance into the Government health insurance exchange program. Start dates will be in the fall, once participation in the exchanges is approved by the Government.Coventry Health Care...

Pre-Authorization Coord - RN/LPN Job

Location: South Jordan Utah

Description: Coventry Health Care is currently interviewing Pre-Authorization Coord - RN/LPN Job right now, this position will be placed in Utah. More details about this position opportunity kindly see the descriptions. Description:
It's a great time to put the strength of Coventry Health Care behind your career! Coventry is currently recruiting for projected openings in our Utah hea! lth plan, Altius, related to our anticipated entrance into the Government health insurance exchange program. Start dates will be in the fall, once participation in the exchanges is approved by the Government.Coventry Health Care provides a full range of risk and fee-based managed care products and services to a broad cross section of employer and government-funded groups, government agencies, and other insurance carriers and administrators.The Pre-Authorization Coordinator is responsible for implementing and coordinating all utilization management functions relating to preauthorization of outpatient testing/surgery, and inpatient admissions.

ESSENTIAL RESPONSIBILITIES

• Assists with the orientation of providers to the Plan's authorization and review procedures and work closely with participating physicians to secure information necessary for utilization management.
• Implements and documents utilization management activities, which incorporate a t! horough understanding of clinical knowledge and appropriatenes! s of medical services related to effective cost containment.
• Ensures the medical necessity and appropriateness of the delivery of healthcare resources provided to members as per their benefit package, through medical review of inpatient and outpatient service requests, utilizing established criteria, clinical judgment, and Medical Director guidelines.
• Actively participates in the negotiation and notification processes that result from the medical record reviews with the facilities. Prepares notification letters of denied and negotiated days within the established time frames.
• Offers safe, effective alternatives to the inpatient setting for those patients requiring interventions prior to their hospitalization. Actively negotiates transitional levels of care when services requested do not meet acute care criteria.
• Utilizes established criteria to authorize hospital admissions, diagnostic testing and ambulatory services, etc.
• Ensure! s that members are utilizing contracted providers requested services are covered benefits, medically necessary, appropriate and of the highest quality.
• Provides oversight of non-clinical staff in the screening of both verbal and written service requests. Serves as resource on clinical issues for non-clinical staff to ensure information provided to members and providers is current and accurate.
• Provides accurate, comprehensive, and pertinent utilization data and information.
• Assists in the identification and reporting of potential quality improvement issues. Responsible for ensuring these issues are reported to the Quality Management Department.
• Performs other duties as required.

Qualifications:
JOB SPECIFICATIONS

• Registered nurse with active state RN license preferred.
• Previous experience (usually 2+ years) in utilization management.
• Significant experience (usually 3+ years) clinical ex! perience.

OR

• Licensed Practical Nurse with acti! ve state LPN license.
• Minimum 3 years utilization management experience required, and
• Minimum 5 years clinical experience required.Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.

Job: Professionals
Primary Location: South Jordan, UT, US
Other Locations: ,
Organization: 30000 - Altius Health Plans
Schedule: Full-time
Job Posting: 2013-10-09 00:00:00.0
Job ID: 1312728

Job Overview

Date Sat, 19 10 2013 00:00:00 GMT
- .
If you were eligible to this position, please email us your resume, with salary requirements and a resume to Coventry Health Care.

If you interested on this position just click on the Apply button, you will be redirected to the official website

This position starts available on: Wed, 30 Oct 2013 00:06:33 GMT

Apply Pre-Authorization Coord - RN/LPN Job Here