Prior Auth Nurse (RN)

Immediate need for a talented Prior Auth Nurse (RN). This is a 03+months contract opportunity with long-term potential and is located in Olympia, WA (Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID:25-80708

Pay Range: $37 - $40/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria.
• Works with healthcare providers and authorization team to ensure timely review of services Reviewing requests about the member and working with providers.
• 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.
• Performs other duties as assigned .
• Complies with all policies and standards .

Key Requirements and Technology Experience:

• Key Skills:RN
• Prior Authorization
• Utilization Management
• Requires Graduate from an Accredited School of Nursing or Bachelor s degree in Nursing and 2 4 years of related experience.
• RN or LPN .
• Must have the licensed requirements sent in, Must reside in SC .

Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

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