Registered Nurse

Duration: 03 Months.

As a Prior Authorization Nurse, you work outside the walls of a hospital setting in a specialty area of the nursing field providing utilization management prior authorization reviews. Build strong direct relationships with providers and medical directors through review of member clinical information, applying criteria, and completing authorization determinations in accordance with company policies and procedures, Document patient care activity and communication with the provider and medical director. Participate in on call rotation as indicated by staffing and business needs.

• Registered Nurse with current license in state of employment. Additional licensure may be required in multi-state service areas.
• Minimum 3 years nursing experience with a minimum of 1 year Utilization Management Prior Authorization experience.
• Advanced user computer skills with excellent customer service skills (written and verbal) a must. Physical Demands:
• Required to use hands to type and work on computer, required long period of sitting at a computer and monitor. Vision requirements include close vision, color vision, night vision, peripheral vision, depth perception and the ability to adjust focus.

Skills: Must Have:

• Utilization Management Prior Authorization Review experience preferred.

Experience:

As a Prior Authorization Nurse, you work outside the walls of a hospital setting in a specialty area of the nursing field providing utilization management prior authorization reviews. Build strong direct relationships with providers and medical directors through review of member clinical information, applying criteria, and completing authorization determinations in accordance with company policies and procedures, Document patient care activity and communication with the provider and medical director. Participate in on call rotation as indicated by staffing and business needs.

Professional Qualification:    

• RN Diploma, Associates or B.S. degree in nursing is required.

Experience Required: 01-03 Years.

Shift: Mon-Fri 8a-5P CST possible rotating on call weekend shift.