Authorization Management Clinical Reviewer

📋 Description

• • As an Authorization Management Clinical Reviewer, you’ll play a vital role in ensuring patients receive the right care at the right time by reviewing acute and post-acute authorizations before submission to the payer and verifying medical necessity using InterQual guidelines.
• • Day to day, you will review authorizations for medical necessity, collaborate with physicians, healthcare providers, case managers, and medical directors to ensure appropriate levels of care, participate in team meetings and educational activities, ensure compliance with federal, state, and accreditation standards, and utilize healthcare system resources to assist physicians and patients effectively.
• • You will join WellSky Corporation, a company dedicated to creating an authentic culture through innovation, inclusiveness, and cohesive perspectives, where independent thinking and collaboration drive improved health outcomes in the medical management process.
• • In this role, you can deepen your clinical expertise in utilization management, gain proficiency with InterQual guidelines and CarePort Care Management, develop leadership through interrater reliability testing and process improvement initiatives, and contribute to cost-effective, high-quality patient care while advancing your professional growth in a supportive, mission-driven environment.