Premier Medical Resources
Clinical Pre-Service Nurse Auditor
Premier Medical Resources, Houston, Texas, United States, 77246
Join to apply for the
Clinical Pre-Service Nurse Auditor
role at
Premier Medical Resources 2 months ago Be among the first 25 applicants Join to apply for the
Clinical Pre-Service Nurse Auditor
role at
Premier Medical Resources Get AI-powered advice on this job and more exclusive features. 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:
www.pmr-healthcare.com
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. Seniority level
Seniority level Mid-Senior level Employment type
Employment type Contract Job function
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Clinical Pre-Service Nurse Auditor
role at
Premier Medical Resources 2 months ago Be among the first 25 applicants Join to apply for the
Clinical Pre-Service Nurse Auditor
role at
Premier Medical Resources Get AI-powered advice on this job and more exclusive features. 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:
www.pmr-healthcare.com
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. Seniority level
Seniority level Mid-Senior level Employment type
Employment type Contract Job function
Job function Health Care Provider Industries Hospitals and Health Care Referrals increase your chances of interviewing at Premier Medical Resources by 2x Get notified about new Clinical Specialist jobs in
Houston, TX . Houston, TX $50,000.00-$60,000.00 9 hours ago Houston, TX $110,000.00-$125,000.00 2 weeks ago Clinical Specialist, Vessel Closure - Houston, TX
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Clinical Applications Specialist, Ultrasound Women's Health (Southern Texas)
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Houston, TX $75,300.00-$150,700.00 2 days ago Clinical Research Specialist (Center for Innovation)
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Houston, TX $90,000.00-$110,000.00 2 days ago Clinical Navigator - FT | Texas Medical Center
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Houston, TX $95,200.00-$143,000.00 1 week ago Pharmacy Clinical Specialist- Full Time Days
We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr