Fabergent
Clinical Care Reviewer
Doral, FL, United States
Sponsorship not specifiedDetected 3283 days ago
ExcelPatient CareMicrosoft Office
About the role
- Advises the referral source and requests specific information necessary to complete the process.
- Completes ASF per policy. • Provides verbal/fax denial notification to the requesting provider as per policy.
Skills
- Current FL RN licensure
- Registered Nurse graduated from an accredited Diploma, Associates Degree or Bachelor's Degree program
- Minimum of 3 years of nursing experience, in related clinical setting, preferably critical care (e.g. ER, ICU)
- Experience with Utilization Review and/or Prior Authorization
- Familiar with Interqual Criterion
- Knowledge of MS Office including Word, Excel, and Outlook
- Verifies and documents member eligibility for services.
- Provides verbal/fax denial notification to the requesting provider as per policy. Generates denial letter in a timely manner.
- Recognizes opportunities for referrals to Care Coordination Department, and refers accordingly.
Benefits
- Health Care Client
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This listing is sourced directly from Fabergent's careers page and normalized into a canonical job model.