Responsible and accountable for coordinating requests for prior authorization received via the Resource Coordination ACD telephone line, fax machine and mail. This position also provides assistance to others as called upon within the department.
Registered nurse with a current New York State license is preferred.
LPN with 2 years utilization management experience required.
Minimum of two (2) years clinical experience is required.
Minimum of two (2) years Resource Coordination experience is preferred.
Demonstrated problem solving and organizational skills and ability to interact with providers, members and community agencies to positively impact the quality of patient care required.
Demonstrated ability to elicit required information, interact professionally with difficult callers, provider practitioners and members with ongoing assistance and education regarding plan requirements.
Demonstrated ability to review health care delivery against established criteria required.
Understanding of coding/claims processing is preferred.
PC skills experience is required.
Salary Grade: 16