Prior Auth Registered Nurse

Immediate need for a talented Prior Auth Registered Nurse. This is a 01+ 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: 25-74793

Pay Range: $30 - $31/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:

• No direct patient care. This is a virtual position.
• Responsible for clinical criteria prior authorization setup, which takes client clinical policy requirements and creates the prior authorization request sent to prescribers.
• This could include questions such as (but not limited to) is the patient 18, does this patient have , has the patient tried and failed these alternative medications etc.
• The creation of questions and answers along with other additional configuration will allow prescribers to answer questions leading to either an approval or denial.
• Clinicians are also responsible for creating and coding denial rationales sent to prescribers and patients.
• The system leveraged for this coding is a web-based platform proprietary to ESI, and selected contractor will be trained on how to leverage this platform.
• Additionally, the individuals should have strong skills with Microsoft office, particularly excel.
• Configuration support will be for both pharmacy and medical criteria and will require good creative problem-solving skills to ensure appropriate setup to meet client needs and maximum operation efficiency.
• Consultative support in explaining setup and system requirements might be needed if discussing criteria setup with other internal ESI business partners.
• An individual with strong and effective communication skills is highly desired.

Key Requirements and Technology Experience:

• Key skills; Licensed RN
• Responsible for clinical criteria prior authorization setup, which takes client clinical policy requirements and creates the prior authorization request sent to prescribers
• Communication, MicroSoft Office, Organization, Self-Driven, Collaboration
• Communication, MicroSoft Office, Organization, Self-Driven, Collaboration
• Demonstrates 'Team Player' and collaborative skills within internal and external teams
• Takes risks by thinking strategically about problems and challenges within their domain
• Communicates effectively within peer group and subordinate groups
• Holds oneself accountable for designated client relationships and the delivery of requests associated to service.
• Capable of & develops robust operational controls to maximize service levels.
• Able to identify the needs of clinical system or process changes to help enhance service levels.
• Ability to comprehend and articulate the importance of assigned responsibilities and controls.
• Able to mitigate concerns of business partners within direct scope of responsibility.
• Able to clearly communicate directly with clients when providing consultative services.
• Licensed RN
• Good communication
• Attention to detail
• Requires RN license that is in good standing as required by the state in which work is performed

Our client is a leading Insurance 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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