Prior Authorization Nurse

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POST DATE 9/3/2016
END DATE 12/19/2016

Confidential Company Miami, FL

Miami, FL
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #


Prior Authorization | Sunrise, FL. | Available Immediately

Our client is seeking a Registered Nurse with 2 years in a Acute Care setting with Prior Authorization Experience. Our client is growing and seeking to add to their staff. The right candidates will promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests.

Job Descriptions:

* Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations
* Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings
* Collaborate with various staff within provider networks and case management team electronically or telephonically to coordinate member care
* Educate providers on utilization and medical management processes
* Provide clinical knowledge and act as a clinical resource to non-clinical team staff
* Enter and maintain pertinent clinical information in various medical management systems

Job Qualifications:

Education/Experience: Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. 2+ years of clinical nursing experience in an acute care setting. Knowledge of healthcare and managed care preferred.

Licenses/Certifications: Current state's RN license. For Corporate - must obtain and maintain RN license in applicable states as needed.

Our client believes in work and life balance, promotion from within, and offer a competitive salary and benefit package.