Prior Authorization Coordinator

Community Health Network of Connecticut, Inc.

. Work collaboratively with Health Services’ staff in conducting medical necessity review activities for Community Health Network members .

Posted 10/3/2026full-timeRemote • Connecticut • United StatesMid-LevelSenior💰 $51,075 - $68,100 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in conducting medical necessity reviews and utilizing InterQual and Medicaid criteria to determine benefit coverage. Maintains knowledge of Medicaid benefits and effectively communicates policies to providers.

Highest-signal resume keywords

Licensed Practical Nurse LicenseMedical Necessity ReviewInterQual Criteria UtilizationMedicaid Benefits KnowledgeAuthorization Request Review

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical Necessity ReviewAuthorization Request ReviewBenefit Coverage DeterminationDME ReviewOutpatient Therapy ReviewInpatient Procedure ReviewThird-Party Liability IdentificationCoordination of BenefitsProofreadingCase Referral

Soft Skills

CollaborationCommunicationProblem-SolvingEducationEscalation

Certifications & Qualifications

Licensed Practical Nurse License

Industry Keywords

MedicaidCommunity Health NetworkHealth ServicesBenefit PackageClinical Information

About the role

Key responsibilities & impact

Work collaboratively with Health Services’ staff in conducting medical necessity review activities for Community Health Network members
Approve or deny services based on benefit package and medical necessity criteria
Respond to telephonic and written authorization and benefit coverage requests from CHNCT providers
Conduct medical necessity reviews for DME, outpatient therapies, and inpatient and outpatient procedures
Identify coordination of benefits needs and third-party liability
Utilize InterQual and/or Medicaid criteria to make decisions
Select, format, proofread, and print member and provider denial letters
Refer cases to the CHNCT Medical Reviewer when clinical information does not support medical necessity
Assist in educating providers on CHNCT policies and procedures
Maintain knowledge of covered Medicaid benefits and share information with clinical staff
Identify and refer cases for Intensive Care Management evaluation
Escalate authorization issues to the Manager for resolution
Review non-par and non-covered service requests and approve or deny them according to guidelines and policies
Perform other duties as assigned

Requirements

What you’ll need

Two years post-secondary schooling
Associate's degree
Licensed practical nursing major
3 to 5 years’ related experience
Active Licensed Practical Nurse License
Knowledge of covered benefits for Medicaid programs
Ability to use InterQual and/or Medicaid criteria to make decisions
Ability to conduct medical necessity reviews and determine benefit coverage
Ability to review DME, outpatient therapy, inpatient and outpatient procedure authorization requests

Benefits

Comp & perks

Medical, dental and vision coverage options
Flexible spending and health savings accounts
Group term life insurance
A 401(k) plan with company-match and immediate vesting
Voluntary accidental injury coverage
Tuition reimbursement and continuing education opportunities
A generous paid-leave bank and company holidays
Wellness program
Inclusive and accessible interview process with reasonable accommodations available