CareContinuum is an innovative, solution-focused healthcare company committed to delivering superior clinical and financial outcomes for our clients.

What others regard as a problem, CareContinuum treats as an opportunity.

We are committed to building win-win partnerships by achieving optimum utilization of healthcare dollars for patients, as well as for providers and payers.

This goal can be achieved through our multi-disciplinary team approach, reinforced by customer service and result-oriented systems, which keep us on target.

In addition, by focusing on early interventions, we can tailor our programs to meet the exact needs of our clients.

RESPONSIBILITIESThe Utilization Clinical Authorization Specialist completes daily prospective and concurrent authorizations on home health or infusion services under the guidance of the nurse case managers.

They must handle multiple duties with excellent prioritizing skills and critical thinking abilities.

When necessary communicates with physician offices, hospitals, patients, and providers.

This position requires excellent customer service skills when dealing with internal and external clients.

Enters into the system prospective and concurrent authorization on assigned home health and infusion requests.

Research and prepare clinical documentation to send to the clinical reviewer.

Process and communicate all home health and infusion service authorizations to providers in a timely manner in accordance with company guidelinesDocument all patient information in the CASI system and submit cases to either a clinical reviewer, or the Manager of the department that need further clinical review.

Maintain accurate documentation for each authorization and coordinate insurance verification for all re-authorization of home health and infusion services.

Perform other duties as assigned.QUALIFICATIONS1. High school diploma or GED. Business and health care courses preferred2 2 years experience in a medical/insurance environment3 Experience in HCPS coding, home health reimbursement and Medicare procedures preferred.

4. Minimum one year experience with Micro Soft to include managing/formulating excel spreadsheets.

5. Ability to communicate articulately and to comprehend written and verbal communications6 Minimum six months experience calculating clinical authorizations7 Attention to details and excellent organizational skills.EEO STATEMENTExpress Scripts is an Equal Employment Opportunity Employer and will not discriminate against or harass any applicant or employee on any grounds prohibited under any federal, state or local law, including race, creed, color, religion, sex, national origin, age, disability, sexual orientation, marital status, status with regard to public assistance, veteran status, citizenship or membership in any other legally protected class.

None of the questions in this application are intended to elicit information regarding any protected characteristics, nor imply any limitation, illegal preferences or discrimination based upon non-job-related information or protected characteristics.We are proud to be an Equal Opportunity Employer.

Applicants must be able to pass a drug test and background investigation and, depending on position requirements, a Department of Defense background investigation.

« Apply for Clinical Authorization Specialist- CareContinuum Job in Louisville, Kentucky US