RN Clinical Review Prior Authorization UM Specialist - Bloomington, MN, United States

Only for registered members Bloomington, MN, United States

3 days ago

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Job summary

HealthPartners is hiring a RN Clinical Review Prior Authorization UM Specialist.

Responsibilities

  • Maintain an understanding of state and federal regulations, accreditation standards, HealthPartners products and networks, member contracts and Health Plan policies and procedures related to Utilization Management
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  • Investigate and respond to complex, high profile, and/or escalated customer questions, issues, and requests.
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  • Responsible for accurately interpreting coverage criteria and making correct determinationsand communicating relevant information to providers and members.
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