Prior Authorization Nurse 9/3/2016
JOB DESCRIPTIONAPPLY 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.
* 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
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.