Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission:
the health and well-being of individuals and communities entrusted to our care.
By joining Parkland, you become part of a diverse healthcare legacy that's served our community for more than 125 years.
Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job.
It's our passion.
Primary Purpose
Reviews requests for prior authorization and appeals for approval or denial of claims payment based on medical necessity.
Oversees medical coordination required for effective utilization and quality management of the health plan network.
Supports the clinical activities of PCHP Utilization Management, Quality Management, Clinical Policy, Technology Assessment, Credentialing, Population Health and Fraud, Waste and Abuse Functions to assure comprehensive, high quality health care to plan members in accordance with managed care and PCHP policies.
Monitors clinical care needed to produce optimal health outcomes and cost-effective care.
Minimum SpecificationsEducation
Must have successfully completed an Accreditation Council for Graduate Medical Education (ACGME) or American Medical Association (AMA) approved residency in an appropriate specialty to the PCHP population.
Experience
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