Libsysinc

Company Details

Prior Authorization Nurse

Job ID

: 21649

Location

: Little Rock, AR, USA

Salary

: $29 per hour

Job Views

: 124

Posted

: 02-28-2019

Key Skills

RN license

Job Description

Job Description:

Position Purpose:

  • 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

 

Qualifications:

Education/Experience:

  • Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred. 2+ years of clinical nursing experience. Knowledge of healthcare and managed care preferred. RN highly perferred

 

Licenses/Certifications:

  • Current State LPN/LVN or RN license.

 

What are the 3-4 non-negotiable requirements on this position?

  • State of AR RN license preferred Medicaid exp highly desired Knowledge of healthcare and managed care
Job Category
Health-Care Nurse
Employment Types
Full time
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