Prior Authorization Nurse

Job title:Prior Authorization Nurse

Location: Arizona ( Remote )

Duration: 3 months

Shift:Monday -Friday 8-5 or 8:30-5

Job Description

· 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.

· Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care.

· Coordinates as appropriate with healthcare providers and interdepartmental teams, to assess medical necessity of care of member.

· Escalates Prior Authorization requests to Medical Directors as appropriate to determine appropriateness of care.

· Assists with service authorization requests for a member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities.

· Collects, documents, and maintains all member’s clinical information in health management systems to ensure compliance with regulatory guidelines.

· Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to members.

· Provides feedback on opportunities to improve the authorization review process for members.

· Reviewing clinicals for procedures against the medical policies to determine medical necessity.

Job Type: Contract

Salary: $40.00 - $42.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Experience:

• Prior Authorization requests: 5 years (Preferred)

License/Certification:

• LPN (Preferred)

Work Location: On the road