....Loading
....Loading
Position Title: Clinical Review Nurse - Prior Authorization
Work Location: Remote (must be clinically licensed in NC, DE, NH, NJ, SC; nationwide sourcing accepted; Compact license preferred)
Assignment Duration: 6 months (Possibility to extend or convert)
Work Schedule: Mon – Fri, 8am-5pm EST, No OT
Work Arrangement: Remote
Position Summary:
Review Prior Authorization requests for various service types for the Medicaid LOB.
Background & Context:
Team is collaborative and supportive; Team is REMOTE but team relies heavily on communication. This initiative is multi state/region.
Key Responsibilities:
• Team member will receive an assignment that is LIVE (excel spreadsheet)
• Team member will process various authorization service types using clinical coverage policies or InterQual.
• Team member will submit any requests that do not meet criteria to second level review (MD) for a determination.
• 12-15 nurse reviews per day
Qualification & Experience:
| Education/Certification | Required: Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing | Preferred: | |||
| Licensure | Required: LPN COMPACT | Preferred: RN Compact | |||
| Years of experience required: 3+ related experience Disqualifiers: Additional qualities to look for: Organized team player who is willing to learn in a fast pace environment | |||||
| 1 | Computer literacy | |||
| 2 | Prior experience with prior authorization | ||||
| 3 | Prior experience using state clinical coverage policies (Medicaid) | ||||
| Candidate Review & Selection | |||||
| Projected Manager Candidate Review Date: | 1-2 days post shortlisting | |||
| Type of Interviews: | TEAMS – camera on | ||||
| Required Testing or Assessment (by Vendor): | NA | ||||