Authorization Management Clinical Reviewer
WellSky
full-time
Posted on:
Location Type: Remote
Location: New York • United States
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About the role
- Review acute and post-acute authorizations for medical necessity using InterQual guidelines
- Collaborate with case managers, physicians, and medical directors to ensure appropriate levels of care
- Participate in team meetings, educational activities, and interrater reliability testing to maintain review consistency and professional growth
- Ensure compliance with federal, state, and accreditation standards, and identify opportunities to enhance communication or processes
- Utilize knowledge of resources available in the healthcare system to assist physicians and patients effectively
- Perform other job duties as assigned
Requirements
- Bachelor's Degree or equivalent work experience
- Active RN License
- At least 4-6 years relevant work experience
- 2 years clinical acute nursing experience
- 1-2 years' of hospital-based utilization management experience
- Denials and Appeals experience (preferred)
- Experience with managed care and CMS standards (preferred)
- UM/CM Knowledge of ICD / CPT / DRG’s (preferred)
- Proficient in the use of window-based computer programs (preferred)
- Excellent verbal, written, and interpersonal communication skills
- Critical thinking skills, creative problem solving, and proficient organization and planning skills
Benefits
- Excellent medical, dental, and vision benefits
- Mental health benefits through TelaDoc
- Prescription drug coverage
- Generous paid time off, plus 13 paid holidays
- Paid parental leave
- 100% vested 401(K) retirement plans
- Educational assistance up to $2500 per year
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
clinical acute nursingutilization managementICDCPTDRGdenials and appealsmanaged careCMS standardsmedical necessity reviewInterQual guidelines
Soft skills
verbal communicationwritten communicationinterpersonal communicationcritical thinkingcreative problem solvingorganization skillsplanning skills
Certifications
Bachelor's DegreeActive RN License