Case Manager: Prior Authorization - REMOTE

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LivaNova is a global medical technology company built on nearly five decades of experience and a relentless commitment to improving the lives of patients around the world. Our advanced technologies and breakthrough treatments provide meaningful solutions for the benefit of patients, healthcare professionals, and healthcare systems. The company is listed on the NASDAQ stock exchange under the ticker symbol “ LIVN .” LivaNova is headquartered in London (UK) with a presence in over 100 countries and a team of more than 3,000 employees worldwide.
 

LivaNova Neuromodulation:

As pioneers of the VNS (Vagus Nerve Stimulation) Therapy® system, LivaNova continues to advance medical device solutions for patients affected by Drug-Resistant Epilepsy (DRE) and Difficult-to-Treat Depression (DTD). There are 3 million people in the U.S. alone and one on three people with epilepsy are drug resistant. People with severe seizures have, on average, a shorter life expectancy and an increased risk of cognitive impairment particularly if the seizures developed in early childhood. VNS Therapy for DRE is delivered through a device that sends mild pulses to the vagus nerve at regular intervals throughout the day in an effort to prevent seizures

The PACM is primarily responsible for the coordination and implementation of the financial (insurance) approval aspect for individuals referred by their treating physicians for vagus nerve stimulation surgery. 

The process is initiated by the PACM following receipt of a physician signed patient identification and qualification (PIQ) form as well as a referral from the territory case manager (assigned to the particular patient). 

The PACM is responsible for completion of payer required forms and medical necessity letter (when required) and payer submission (per payer requirements). 

In the event a payer requires submission by service provider via payer portal, PACM will assist service provider according to provider preference. 

The PACM is responsible for payer follow-up specific to submitted authorizations and updating database appropriately. This role maintains communication with others involved in the verification and care coordination process, including but not limited to the territory Case Manager, Verification Specialist & Reimbursement Specialist. Prior Authorization Case Managers (PACMs) collaborate) to ensure that authorization needs are met within an acceptable timeframe. 

The PACM reports to the Case Management Manager.

Primary Activities

• Serves as a resource to other members of the PACM team, providing guidance specific to insurance/payer issues and authorization submissions and follow-up (Team Leader)

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