Prior Authorization Medical Clinician
W
WellSense
📍 United States, REMOTE, United States
Job Description
Position Type
Full-Time/Regular
It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.
**Job Summary:**
The Prior Authorization Clinician is responsible for reviewing all proposed hospitalization, home care, and inpatient/outpatient services for medical necessity and efficiency to ensure members receive the appropriate and timely care to support members in achieving optimal health outcomes.
Our Investment in You:
· Full-time remote work
· Competitive salaries
· Excellent benefits
**Key Functions/Responsibilities:**
· Determines medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines **applying evidenced-based** InterQual® **criteria, Medical Policy and benefit determination....
Full-Time/Regular
It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.
**Job Summary:**
The Prior Authorization Clinician is responsible for reviewing all proposed hospitalization, home care, and inpatient/outpatient services for medical necessity and efficiency to ensure members receive the appropriate and timely care to support members in achieving optimal health outcomes.
Our Investment in You:
· Full-time remote work
· Competitive salaries
· Excellent benefits
**Key Functions/Responsibilities:**
· Determines medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines **applying evidenced-based** InterQual® **criteria, Medical Policy and benefit determination....