Remote Prior Authorization Nurse (LPN/LVN, RN) – NY & Compact

Managed Care Network, Inc. is an established managed care company who strives to be the best employer in the P&C marketplace by living our values and by providing a work environment that employees can be proud of. Through our company values, we promote employee growth so each person can Thrive and are appreciated for the expertise, hard work, and passion they bring to the company. We provide unique solutions quickly to solve problems and to make our customers jobs easier.

We take pride in our teamwork, setting us apart of the rest of the industry and allowing our company to grow; which in turn allows our staff to grow both personally and professionally. Through our company mission statement, allows us to serve our customers, by being a reliable and dependable partner to achieving their goals. Your work will be valued each and every day and your impact to our customers will be recognized.

Position Overview:

The PAR review Nurse grants or denies prior authorizations for medications, durable medical equipment (DME) or medical treatment in workers compensation cases based on the relevant Medical Treatment Guidelines and the prior treatment history of each case.

Key Responsibilities:

Reviews workers compensation cases for details on what body parts have been authorized for treatment as well as the prior treatment and outcomes

Reviews prior authorizations requests and considers all relevant factors

Reviews each workers compensation case for details on what injuries are work related, what body parts have been authorized for treatment, as well as the prior treatment and outcomes

Reviews the prior medical treatments and authorizations

Reviews the relevant New York Workers Compensation Medical Treatment Guidelines, Pharmacy Formulary or DME Fee Schedule

Reviews the medical provider’s prior authorization request

Consults with legal department and other departments when needed to fully understand the proposed request and its ramifications for the case

Grants or Denies each prior authorization request within the allotted timeframe

Qualifications:

Must be a New York Registered Nurse (RN) or a Licensed Practical Nurse (LPN)

Must understand workers compensation medical treatment guidelines

Strongly prefer experience working in Compliance, Prior Authorizations, NYS Workers Compensation Medical Treatment Guidelines, Pharmacy, Utilization review

Attention to Detail necessary

Must have excellent computer skills, and excellent analytical and communication skills.

Ability to adapt and quickly develop an understanding of new and different applications.

Excellent time management skills

Must be able to work independently and multi-task

Job Type: Full-time

Pay: $60,000.00 – $80,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off

License/Certification:

• LPN (Required)
• RN License (Required)

Work Location: Remote