Why Community Health Network of Connecticut
FY2024 · Form 990Its mission and biggest programs, as filedImproves Connecticut's health and access to quality, affordable care for over a million residents.
- Connecticut medicaid medical administrative services program: through its medicaid medical administrative services program, chnct provides medical administrative services to over 940,000 underserved and vulnerable members of connecticut's medicaid population who participate in the Connecticut department of social services' husky Health…$81.1M spent in FY2024
- Environmental support charitable grant program: through its environmental support charitable grant program, chnct makes unrestricted charitable grants to chnct's seven founding federally qualified Health centers ("fqhcs") located in the state of Connecticut. Each grant recipient fqhc is a publicly supported…$1.2M spent in FY2024
- In 2024, chnct continued to receive funds directly related to third party liability claims overpayment recovery audit work conducted by first recovery (fr). Since chnct entered into the agreement with CT dss as the medicaid program's medical administrative services organization…−$3K spent in FY2024
Before you apply
FY2024 · Form 990Independent: from IRS data, not the orgAbout the role
The org's own posting, as writtenCommunity Health Network of Connecticut, Inc. (CHNCT) is currently seeking a Prior Authorization Coordinator to join our team.
Primary Responsibilities
Works collaboratively with Health Services’ staff in conducting medical necessity review activities for Community Health Network members. Approves or denies services based on benefit package and medical necessity criteria. Tasks Performed: Responds to telephonic and written requests by CHNCT providers for authorization and benefit coverage for CHNCT members. Conducts medical necessity review of requests for DME, outpatient therapies and prior authorizations for inpatient and outpatient procedures. Identifies need for coordination of benefits and identifies third party liability as appropriate. Utilizes the InterQual and or Medicaid criteria to make decisions.
Selects, formats, proofreads and prints appropriate member and provider denial letters prior to mailing. Refers cases to CHNCT Medical Reviewer when clinical information does not support medical necessity. Assists in education of primary care providers, specialists and ancillary providers on CHNCT policies and procedures. Performs other duties as assigned.
Essential Functions
Maintains knowledge of covered benefits for Medicaid programs. Shares information as necessary with appropriate clinical staff. Identifies and refers cases appropriate for Intensive Care Management evaluation. Identifies authorization issues and brings those requiring attention to the Manager for resolution. Reviews requests for non-par services and approves or denies based on guidelines/policies. Reviews requests for services not included in member’s benefit package.
Desired Education: Two years post-secondary schooling Desired Degree: Associate's degree Desired Major: Licensed practical nursing Desired Job Experience: 3 to 5 years’ related experience Certifications Required: Active Licensed Practical Nurse License CHNCT Offers Great Benefits: 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 We are dedicated to having a workplace where everyone feels valued, respected, and empowered to succeed.
We embrace a wide range of perspectives and backgrounds, ensuring fair treatment and opportunities for all employees. We value our team’s rich array of experiences and viewpoints, which contribute to our innovative and collaborative environment. We are committed to providing an inclusive and accessible interview process. If you require a reasonable accommodation for your interview due to a disability. Please contact us in advance if you need an accommodation.
About Community Health Network of Connecticut
From its Form 990- Budget $84.1M · Health Care
- Staff 528 · founded 1995
- Pays its leaders $253K–$680K (12 reported)
- Open jobs 7 · Jobs at Community Health Network of Connecticut · Full 990 report