Prior Authorization RN Case Manager-Urgent

Prior Authorization Nurse Case Manager (PACM)

The role of the Prior Authorization Nurse Case Manager (PACM) is to promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization specialty referral requests. The PACM will review for appropriate care and setting, and following guidelines/policies, will approve services when indicated. If not indicated, PACM will forward requests to the appropriate physician or medical director with recommendations for other determinations, ensuring that the member is receiving the appropriate quality care in a preferred setting, while making sure regulatory guidelines are followed.

Responsibilities

• Understand, promote and review with appropriate medical management to facilitate the right care at the right time in the right setting.
• Communicate effectively and interact with providers, staff and health plans ...

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