Prior Authorization Specialist

Job Summary

A company is looking for a Prior Authorization Specialist to join their care management team.

Key Responsibilities

• Review medical documentation to determine medical necessity for requested services
• Apply established criteria and clinical guidelines for prior authorization requests
• Communicate authorization outcomes to providers, patients, and payers in a timely manner

Required Qualifications

• Active CNA/LNA or prior clinical experience strongly preferred
• Minimum of 2 years in home health, skilled nursing, rehab, or behavioral health
• Strong knowledge of ADLs, clinical documentation, and medical terminology
• Proficiency with EMR/CRM systems
• Must be a resident of New Hampshire