Community Health Network of Connecticut, Inc.
Community Health Network of Connecticut, Inc.
Community Health Network of Connecticut, Inc. एक गैर-लाभकारी स्वास्थ्य योजना संस्था है, जो जनसंख्या स्वास्थ्य प्रबंधन और देखभाल समन्वय के माध्यम से कनेक्टिकट में सेवाएँ प्रदान करती है। इसका कार्य डेटा विश्लेषण, सदस्यों और प्रदाताओं की भागीदारी तथा साक्ष्य-आधारित देखभाल हस्तक्षेपों को एक साथ जोड़ता है, ताकि पुरानी बीमारियों से जूझ रहे लोगों, देखभाल के विभिन्न चरणों के बीच बदलाव से गुजर रहे लोगों और स्वास्थ्य के सामाजिक निर्धारकों से प्रभावित लोगों को सहायता मिल सके। यह संस्था स्वास्थ्य परिणामों में सुधार, सेवाओं के समन्वय तथा स्वास्थ्यसेवा के उपयोग और लागतों के प्रबंधन में मदद करने के लिए सामुदायिक साझेदारों के साथ भी काम करती है। इसके 501–1,000 सदस्यों वाले दल का कार्य स्वास्थ्यसेवा, बीमा और परामर्श के संगम पर होता है, और यहाँ की नियुक्तियाँ इन क्षेत्रों की विशेषज्ञता से जुड़ी होती हैं।

Remote Prior Authorization Coordinator - Connecticut

Review Medicaid authorizations and medical necessity for Community Health Network of Connecticut members. Apply InterQual criteria and coordinate provider communications about coverage decisions and denials.

विवरण

  • Collaborate with Health Services staff on medical necessity reviews for Community Health Network members
  • Approve or deny services using benefit packages and medical necessity guidelines
  • Handle telephone and written authorization and benefit coverage requests from CHNCT providers
  • Review authorization requests for durable medical equipment, outpatient therapies, and inpatient and outpatient procedures
  • Assess coordination-of-benefits requirements and third-party liability
  • Apply InterQual and Medicaid criteria when making authorization decisions
  • Prepare, format, proofread, and print denial letters for members and providers
  • Refer cases to the CHNCT Medical Reviewer when clinical documentation does not support medical necessity
  • Help providers understand CHNCT policies and procedures
  • Keep current with covered Medicaid benefits and communicate updates to clinical staff
  • Identify cases that may require Intensive Care Management evaluation and make referrals
  • Escalate authorization concerns to the Manager for resolution
  • Evaluate non-participating provider and non-covered service requests under applicable guidelines and policies
  • Complete additional assigned duties

आवश्यकताएँ

  • Completion of two years of post-secondary education
  • Associate degree
  • Major in practical nursing
  • Three to five years of related experience
  • Current Licensed Practical Nurse license
  • Working knowledge of covered benefits under Medicaid programs
  • Ability to apply InterQual and Medicaid criteria when making decisions
  • Ability to perform medical necessity reviews and determine benefit coverage
  • Ability to evaluate authorization requests for durable medical equipment, outpatient therapy, and inpatient and outpatient procedures

लाभ

  • Medical, dental, and vision coverage options
  • Flexible spending and health savings accounts
  • Group term life insurance
  • 401(k) plan with company matching and immediate vesting
  • Voluntary accidental injury coverage
  • Tuition reimbursement and continuing education opportunities
  • Paid-leave bank and company holidays
  • Wellness program
  • Inclusive, accessible interview process with reasonable accommodations available

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