*Provide accurate disposition of prior authorization requests submitted by providers for Medicaid fee-for-service
recipients, involving specific services through analysis of abstract submissions, medical records, orders &
documentation
*Review and apply criteria, collect, research and organize information to use in reviews. Requests are for waiver
services under the Disabled and Elderly Waiver
*Review and determine appropiateness of level or care requests and plan of care requests for waiver services
*Appropiately refer reviews not meeting criteria to peer consultants, including medical directors
*Refer potentially fraudulent clams to management
*Maintain complete confidentiality of protected health information
Requirements:
*RN's/LPN's with unrestricted license in the State of New Mexico
*2+ years experience