Required Skills/Experience: | Preferred Skills/ Experience: | ||||||
1. | Previous PA experience and experience in MM or UM. | 1. | Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred. | ||||
2. | Strong computer skills-ability to navigate multiple systems | 2. | Knowledge of Medicare and Medicaid regulations preferred. | ||||
3. | 3. | Knowledge of utilization management processes preferred. | |||||
Education Requirement: | Requires Graduate from an Accredited School of Nursing or bachelor’s degree in nursing and 2 – 4 years of related experience. | Education Preferred: | |||||
Software Skills Required: | |||||||
Required Certifications: | LPN - Licensed Practical Nurse - State Licensure required Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria | Required Testing: |