Guidesoft Inc. dba Knowledge Services

  • Prior Authorization Nurse

    Posted Date 3 weeks ago(9/27/2018 2:46 PM)
    Job ID
    2018-12596
    Job City
    Indianapolis
    Job State
    Indiana
  • Overview

    Long term contract opportunity (potential for hire) for a Prior Authorization Nurse (LPN or RN) with a well-established client in Indianapolis.

     

    Knowledge Services,  established in 1994 and headquartered in Indianapolis IN, is a certified woman-owned (WBE) professional services organization with over 1500 employees located in offices throughout North America.  Founded by Julie Bielawski, CEO, Guidesoft, Inc. DBA Knowledge Services is an industry leader in Managed Service Programs (MSP), Employer of Record / Payrolling Services, National Recruitment, and Staffing Services.  We provide outstanding services to major organizations in various industries, including; IT, Healthcare, Entertainment, Media, Federal and State Governments, Public Utilities, Telecom, Manufacturing and more.

     

    Knowledge Services has benefit offerings to include the following!

     

    • Medical, dental, and vision coverage
    • Voluntary Life and AD&D coverage
    • Pet Insurance
    • Ticket and Event discounts!
    • The above are available provided contractors meet eligibility requirements

    Responsibilities

    Knowledge Services is seeking a Prior Authorization Nurse (LPN or RN) for a well-established client in Indianapolis.

     

    This is a long term contract opportunity with the possibility to be hired on.

     

      • Utilize and follow established preauthorization review process for outpatient and inpatient services.
      • Determine medical necessity of inpatient hospitalization.
      • Utilize pre-approved criteria and guidelines to validate medical necessity of pre-service and continued stay, and appropriateness of treatment and discharge planning.  
      • Evaluate patient medical records when determining benefit coverage, including appropriateness and level of care.
      • Collaborate as directed with appropriate personnel for members with complex medical conditions.
      • Act in conjunction with appropriate team members on a daily basis to assess the inpatient census for appropriate alternative health care service needs.    
      • Communicate with physicians and ancillary providers to coordinate member care.
      • Coordinate with appropriate discharge planning team members, facility utilization management department, physicians and members to coordinate timely discharges.    
      • Maintain accurate and timely documentation in accordance with corporate policies/procedures, business, regulatory and professional accreditation standards.
      • Display sensitivity to diverse cultural, religious, economic, and social groups, and their relationships to the knowledge, delivery, and acceptance of healthcare delivery services, and make appropriate interventions as indicated.

    Qualifications

    Required: Experience with Prior Authorizations

    • Current unrestricted Indiana LPN or RN
    • Three (3) years' clinical experience.
    • Three (3) years' utilization review experience.
    • Strong background in prior authorizations; Medical Assistance; ICD Coding; claims/benefits.
    • General knowledge of Medical Management practices and Managed Care principles.
    • General knowledge of regulations that are used in delivering utilization management.
    • Demonstrated knowledge of MCG guidelines preferred
    • Ability to evaluate medical records and other health care data
    • Ability to effectively prioritize multiple tasks and deadlines, and accurately complete tasks within established timeframes
    • Ability to communicate effectively both orally and in writing.

    INDMEDSC

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