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Pre-Authorization ClinicianBoston Medical Center Healthnet Plan - Springfield, MAEvaluates and approves requested services using Organizational Policies or InterQual screening criteria. Manages cases requiring single services such as skilled home nursing visits post in-patient stay for up to six weeks. Educates providers on the Plan's benefits and policies as needed, functions as liaison between providers and BMCHP staff as it relates to the authorization of services, tracks relevant metrics data and reports cost savings, denials, variances, and network trends/needs to supervisor. Key Functions & Responsibilities: * Verifies member eligibility at the time of service. * Reviews cases referred by the pre-authorization staff according to member benefits, provider availability, and pre-determined medical necessity criteria. * Determine the medical necessity of initial orcontinuing...originally from Boston Medical Center HealthNet Plan - More Tools...
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