Prior Authorization RN Needed

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POST DATE 8/20/2016
END DATE 11/17/2016

ALL's WELL Waltham, MA

Job Classification
Full Time
Company Ref #
Required Licenses/Certifications
Waltham, MA
Job Type
AJE Ref #


Direct Hire/Permanent Role
Rate- $61-77k
Mon-Friday 8a-5p

Position Purpose: 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
We are an equal employment opportunity employer and will consider all qualified candidates without regard to disability or protected veteran status.

Job Experience:

-Associate?s degree in 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.