Clinical Clinical Review Nurse Prior Authorization J00927
Share
Job Location:
Tallahassee, FL - USA
Monthly Salary:
Not Disclosed
Posted on:
9 hours ago
Vacancies:
1 Vacancy
Job Summary
Job Title: Clinical Review Nurse Prior Authorization
Assignment Duration: 3 months (Possible Extension or conversion)
Work Location: Fully Remote
Schedule may vary: Training will be 8am-5pm Monday through Friday. Once training is completed the scheduled will either be Tuesday- Saturday- 10a-7pm Tuesday -Saturday or Sunday- Thursday 10a-7pm. Manager will review schedules in the interview as well.
Pay rate: $40-45.00XX
Key Responsibilities
- Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards contractual requirements and a members benefit coverage.
- Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care.
Required Qualifications
Education
- Required: Requires Graduate from an Accredited School of Nursing or Bachelor s degree in Nursing and 2 4 years of related experience.
Licensure
- RN
Years of experience required: 2-4 years prior authorization experience from the insurance side.
Work Environment
- Proficiently navigating all required programs systems and computer applications
- The ability to work efficiently and accurately in a fast paced environment
- Being a team player who can adapt well to change
Key Skills
- CSS
- Cloud Computing
- Health Education
- Actuary
- Building Electrician
