Skip to contentHealth Clinical Services Representative
| Company | Accenture |
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| Location | Austin, TX, USA |
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| Salary | $50800 – $150400 |
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| Type | Full-Time |
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| Degrees | Bachelor’s |
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| Experience Level | Junior, Mid Level |
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Requirements
- Valid and current RN license able to work in the state of Texas.
- 1 year of experience in Prior authorization process.
- 1 year of experience in medical necessity review of Long term care assessments.
Responsibilities
- Manage review clinical FH packets.
- Assess validity of MN determinations.
- Collaborate with physicians and clinical health professionals.
- Utilize and apply medical policies and TAC criteria.
- Participate in open forum for Fair Hearing process inclusive of appellant, physicians, lawyers, and stakeholders.
Preferred Qualifications
- Associate Degree/Diploma.
- Advanced HM Clinical Data Review.
