PAM Health Corp Business Office logo
PAM Health Corp Business Office

PAM HEALTH (PAM) based in Enola, Pennsylvania, provides specialty healthcare services through more than 80 locations, as well as wound clinics and outpatient physical therapy locations, in 17 states. PAM Health is committed to providing high-quality patient care and outstanding customer service, coupled with the loyalty and dedication of highly trained staff, to be the most trusted source for post-acute services in every community it serves. Its mission is to serve people by providing compassionate, expert care, and to support recovery through education and research. Joining our PAMily allows you to work in a collaborative environment with colleagues and leadership with exposure to a variety of patient care levels. Aside from our competitive pay, generous paid benefit time, and excellent insurance options, you will also have opportunities for professional growth through our Education Advancement Program. We are excited to learn more about you and hope that you consider joining us on a shared mission to improve the lives of others by being an integral part of our We Care Program. Please take a moment to visit us online at www.PAMHealth.com for a comprehensive look at how we're able to positively impact our local communities.

Clinical Authorization Specialist

Medical ReviewerMedical ReviewerFull TimeRemote

Location

United States

Posted

20 days ago

Salary

Not specified

No structured requirement data.

Job Description

The Clinical Authorization Specialist is responsible for managing Commercial and Medicare Advantage admission authorizations by conducting a comprehensive analytic review of clinical documentation to determine if a patient is clinically appropriate for admission and the best course of action to obtain authorization from the payer. Write sound, compelling, factual arguments for the purpose of admission and/or to overturn a denial received from a payor for admission.

Job Requirements

  • Bachelors or Associates degree in nursing preferred.
  • Knowledge in the area of LTAC and IRF Criteria including: Medicare, InterQual and Milliman are preferred.
  • Currently licensed as an RN, preferred.
  • Five years (5) experience as a clinical nurse in an acute care setting.
  • At least two years of experience in appeals, case management, discharge planning and/or utilization review is preferred.

Benefits

  • Medical Benefits: EPO/HDHP/HSA options, including prescription coverage, Rx ’n Go, and Teladoc.
  • Comprehensive dental and vision benefits.
  • Employee Assistance Program, including counseling, legal, and financial service.
  • Flexible spending (FSA) and health savings (HSA) accounts.
  • Life and Disability insurance benefits.
  • Education/In-Service Opportunities including continuing education and tuition assistance.
  • Supplemental benefits: Accident, critical illness, cancer, pet, and identity theft protection insurance options.
  • Auto, Home, Cell Phone, and Gym Membership discount offerings.
  • Personal Travel Discounts.
  • Employee Bonus Referral Program.
  • 401(k) plans and discretionary employer match.
  • Generous Paid Benefit Time.

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