This job posting is no longer active. Click here to see other jobs.
Prior Authorization Nurse (RN/LPN)
Tempe, AZ 85285
A-Line Staffing Solutions
Posted 5 weeks ago
Discuss pay at interview
Prior Authorization Nurse (RN/LPN) -Tempe, AZ
Hours : Monday Friday, 8am -5pm, no weekends or holidays, voluntary overtime available.
Prior Authorization Nurse (RN/LPN) Requirements:
- 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
- Bachelor's degree in Nursing preferred.
- Previous experience in prior authorization, concurrent review, case management, utilization review, managed care or similar
- Licenses/Certifications: Current State LPN/LVN or RN license.
[Click Here to Email Your Resum ]
prior authorization, concurrent review, case management, utilization review, managed care, health plan, medical management, population health, medical necessity, HEDIS, STARS, level of care, reviews, admissions, discharge, health coach, determinations, telephonic