Job Description
Work Location: Ohio - Remote (EST)
Duration: 6 months, possible extension
Schedule: Monday thru Friday, 8 am - 5 pm (adjustable based on PA team need, no OT)
Position Summary:
• Review of prior auth requests for Medicaid Line of Business.
• To assist the PA Team reviewing a backlog of requests from providers.
Background & Context:
The PA team works well together - always assisting each other as needed. Teams work closely together and very supportive.
Biweekly team huddles (virtual), and attention to emailed team instructions, proficient in toggling between multiple systems.
To assist the PA Team reviewing a backlog of requests from providers.
Key Responsibilities:
• Review of prior auth requests for Medicaid Line of Business.
• Biweekly team huddles (virtual), and attention to emailed team instructions, proficient in toggling between multiple systems.
• Quality documentation, timely processing of up to 18 authorizations per day on average, team player with positive attitude.
Qualification & Experience:
• Required: Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience.
• Required: Nursing Licensure.
• Must haves: Computer skills, medical knowledge, care manager or clinical nursing experience.
• Nice to haves: Prior Authorization Nurse, Medical Review Nurse, Appeals Nurse, Utilization Management or Quality Assurance Nurse.
| Candidate Requirements | ||||
| Education/Certification | Required: Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience. | Preferred: | ||
| Licensure | Required: Nursing Licensure | Preferred: | ||
| Must haves: Computer skills, medical knowledge, Care manager or clinical nursing experience Nice to haves: Works well for this role: Prior Authorization Nurse, Medical Review Nurse, Appeals Nurse, Utilization Management or Quality Assurance Nurse Performance indicators: (Meet expectations) Quality documentation, timely processing of up to 18 authorizations per day on average, team player with positive attitude | |||
| 1 | Computer skills | ||
| 2 | Prior authorization previous experience | |||
| 3 | Medical knowledge | |||
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At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws. This position’s starting pay is: $39.44/hr.