Clinical Review Nurse - Prior Authorization

Immediate need for a talented Clinical Review Nurse - Prior Authorization. This is a 06+months contract opportunity with long-term potential and is located in U.S(Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID:25-71948

Pay Range: $35 - $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:

• Shift Time & Working Days: Monday Friday (8 hours).
• In the beginning they will not have a set weekend commitment. Once the new hire is fully trained, they are going to have to work (8) hours per day Monday Friday. (Can be EST (highly preferred), CST (second preference).
• Hiring leaders are open to working with various times. (8:00 a.m. 5:00 p.m. can work within their time zone).
• Reviewing authorization requests.
• Utilizing evidence-based criteria and making a medically necessary determination.
• Outreach calls to providers to request additional details if applicable.
• They will not be completing any calls to members.
• Productivity requirement will be discussed upon hire.
• After completing IT training there will be training with teams learning and development team (~4-week course).
• Will be learning about the medical management system in which they will be working within.
• Shadowing with fellow team member / preceptor (RN) to ensure they are equipped with all information and materials.
• Clinical Review Nurse - Prior Authorization, utilization review nurse, prior authorization nurse.
• The team is focused on ensuring that members receive the care needed.
• Ensuring quality care is provided.
• Collaborative team and atmosphere.

Key Requirements and Technology Experience:

• Key Skills: Prior Authorization .
• RN with BSN .
• Intensive Care, Med-Surg, Home health .
• Case management experience is not what the team is looking for, even though they work with this team.
• Please ensure the candidate has a background in utilization review nurse, or prior authorization nurse.
• Someone who was just graduated nursing school.
• ICU, Medical Surgical background, bedside experience (Home health nurses)
• Utilization Review (Prior Authorization)
• Acute Care .
• Bachelor s with RN or RN without bachelor s is okay too.
• TruCare is the system the team uses so if they have experience it is beneficial. Microsoft Office Systems.
• Certifications: RN is what the team is really looking for (If the person has an RN license without a bachelors, they are okay) LPN - Licensed Practical Nurse - State Licensure required Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria.
• Medicare experience (Utilization Management with Medicare)
• CCM Certification
• ACLS Certification

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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