Premier Medical Resources is looking for a Full-Time Clinical Pre-Service Nurse Auditor to join our team!
The Clinical Pre-Service Auditor will provide/confirm precertification of and all authorization requests. The Clinical Pre-Service Auditor will assist with minimizing denials by way of ensuring medical criteria / medical necessity is met prior to services are scheduled. This process includes clinical judgement, utilization management, application, understanding of payor protocols requirements, and verification of medical necessity utilizing nationally recognized criteria.
ESSENTIAL FUNCTIONS:
• Works as part of integrated team and is involved in reviews of authorization requests and communicates with the physicians and clinic when additional information is needed.
• Performs activities that include obtaining payer authorization for outpatient services that require notification/authorization based on payer specific guidelines.
• Maintains a thorough understanding of the plan's provider contracts, authorization requirements and ongoing follow-up and re-evaluation of clinical departments/areas as requested or needed for authorization review.
• Compiles and maintains established payer protocols to determine the medical appropriateness of ordered pre and post scheduled services.
KNOWLEDGE, SKILLS, AND ABILITIES:
• Familiar with hospital coding and billing processes.
• Knowledge of InterQual/Milliman guidelines, Medicare guidelines
• Above average verbal and written communication skills
• Other Skills: Analytical, Mathematics, Medical Terms
• Must be able to interact successfully in a culturally diverse environment
EDUCATION AND EXPERIENCE:
• Nurse in good standing, currently licensed in the State of Texas without stipulations in practice as a Licensed Vocational Nurse
• Three (3) years of hospital experience in various clinical areas.
• One (1) year utilization review, authorization, or case management experience
BENEFITS:
• 3 Medical Plans
• 2 Dental Plans
• 2 Vision Plans
• Employee Assistant Program
• Short- and Long-Term Disability Insurance
• Accidental Death & Dismemberment Plan
• 401(k) with a 2-year vesting
• PTO + Holidays
Please visit our website for more information:
Premier Medical Resources is a healthcare management company headquartered in Northwest Houston, Texas. At Premier Medical Resources, our goal is to leverage and combine the expertise and skillset of our employees to drive quality in all we do. Our goal is to create career pathways for our employees just starting their professional career, and to those who seek to bring their expertise and leadership as we strive to combine best practices and industry excellence. Come join our team at Premier Medical Resources where passion and career meet.
Compensation to be determined by the education, experience, knowledge, skills, and abilities of the applicant, internal equity, and alignment with market data.
Employment for this position is contingent upon the successful completion of a background check and drug screening.
Duration: 3-6 months Location: Onsite Preferred (one day a week)~8-10 years of SAP Supply Chain experience ~ SAP XPS Techno/Functional consultant experience is a must. Integration to 3PL, Warehouse, and Label printing ~ Understanding the Internal Tables, functional...
...JOB TITLE: Enterprise Systems Training Coordinator Location: North Fort Myers, FL Work Hours: Monday - Friday 8:00 am - 5:00 pm Our benefits include: ~ Company-wide annual incentive plan ~ Medical, vision and dental insurance ~401(k) plan with a generous...
...Position Overview: As Director, Growth Analytics you will be pivotal in managing the reporting and audience needs for a major client while also serving as a consultant to all Mediabrands planning stakeholders. In addition to managing the day to day needs of internal...
...talented and industrious Junior Architect to join our dynamic, medium size office. Must be a quick learner with a strong familiarity in BIM modelling and NYC Zoning and Building Code requirements. If you are looking for an opportunity to increase your technical skill,...
...schools in China authorized by the International Baccalaureate Organization(IBO). Offering boarding and day school facilities, it caters to students inprimary, middle, and high school levels, encompassing both local andinternational students. With a diverse community...