RC Pre-Authorization Clinician - Remote
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 tot his job