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Overnight Prior Authorization Rn Jobs in California

Prime Staffing

Travel ED Case Manager

Orange, CA · On-site

Prior Authorization Management * Regulatory Compliance * CMS & Medicare Guidelines * DRG Review * HIPAA Compliance * Interdisciplinary Collaboration The ideal candidate is a detail-oriented RN Case ...

Molina Healthcare

Care Review Clinician (RN)

Long Beach, CA · On-site +1

$23.76 - $51.49/hr

... prior authorization/financial responsibility for Molina and its members. • Processes requests ... • Registered Nurse (RN). License must be active and unrestricted in state of practice. • ...

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Overnight Prior Authorization Rn information

What is the difference between Overnight Prior Authorization Rn vs Medical Assistant?

AspectOvernight Prior Authorization RnMedical Assistant
CredentialsRegistered Nurse (RN) licensePost-secondary certificate or diploma
Work EnvironmentHospitals, clinics, insurance companiesDoctor's offices, clinics, outpatient facilities
Job FocusReviewing insurance authorizations, patient advocacyAssisting with patient care, administrative tasks

The Overnight Prior Authorization RN primarily handles insurance approvals and patient advocacy during overnight shifts, requiring RN licensure. In contrast, Medical Assistants focus on direct patient care and administrative support in outpatient settings. While both roles support healthcare operations, their credentials, responsibilities, and work environments differ significantly.

What is an Overnight Prior Authorization RN?

An Overnight Prior Authorization RN is a Registered Nurse who works overnight shifts to review and process requests for prior authorization of medical services, procedures, or medications. Their role involves evaluating clinical documentation to determine if requested treatments meet insurance or organizational guidelines for approval. These nurses collaborate with providers, patients, and insurance companies to ensure timely and appropriate care. Working overnight allows for 24/7 coverage, supporting urgent cases and maintaining continuous workflow in healthcare authorization departments.

What are some unique challenges faced by Overnight Prior Authorization RNs, and how can they effectively manage them?

Overnight Prior Authorization RNs often work independently with limited immediate support, which can present challenges such as handling complex cases without direct peer consultation and maintaining focus during non-traditional hours. They must be adept at managing high volumes of authorization requests, prioritizing urgent cases, and communicating effectively with providers and insurance companies outside regular business hours. Staying organized, utilizing clear documentation, and leveraging electronic health record systems can help manage workload efficiently. Building strong relationships with day-shift colleagues for smooth case handoffs is also crucial for success in this role.

What are the key skills and qualifications needed to thrive as an Overnight Prior Authorization RN, and why are they important?

To thrive as an Overnight Prior Authorization RN, you need a current RN license, strong clinical judgement, and in-depth knowledge of insurance guidelines and medical necessity criteria. Familiarity with prior authorization software, electronic health records (EHR), and payer-specific systems is typically required. Exceptional attention to detail, critical thinking, and effective communication skills are vital for navigating complex cases and collaborating remotely. These skills ensure timely and accurate authorization decisions, supporting patient care and compliance during overnight shifts.
What are the most commonly searched types of Prior Authorization Rn jobs in California? The most popular types of Prior Authorization Rn jobs in California are:
What cities in California are hiring for Overnight Prior Authorization Rn jobs? Cities in California with the most Overnight Prior Authorization Rn job openings:
Overnight Prior Authorization Rn jobs near you
Care Review Clinician (RN) Remote

Care Review Clinician (RN) Remote

Molina Healthcare

Long Beach, CA • On-site

Full-time

Posted 13 days ago

Molina Healthcare rating

8.1

Company rating: 8.1 out of 10

Based on 193 frontline employees who took The Breakroom Quiz

134th of 281 rated insurance

Job description

JOB DESCRIPTION 

This RN will act as a Care Review Clinician supporting our Medicaid members who have recently been admitted to this hospital. The Medicaid will support them to ensure a successful transition from inpatient to discharge to either a nursing facility or back to their home. The position is a combination of phone call outreach and in person meetings with the members while still inpatient. Excellent computer skills and attention to detail are very important to multitask between systems, talk with members on the phone, and enter accurate contact notes. 

This is a telephonic remote position and productivity is important. Preferred candidates will have previous utilization management, case management, managed care, or inpatient hospital experience. Experience in a behavioral health setting would be a plus.

Schedule: Monday through Friday 8:00AM to 5:00PM EST 8 hours (Weekends, no nights, no call.) 

Job Summary

Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. 
Essential Job Duties 
Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. 
Analyzes clinical service requests from members or providers against evidence based clinical guidelines. 
Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. 
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. 
Processes requests within required timelines. 
Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner. 
Requests additional information from members or providers as needed. 
Makes appropriate referrals to other clinical programs. 
Collaborates with multidisciplinary teams to promote the Molina care model. 
Adheres to utilization management (UM) policies and procedures. 
Required Qualifications 
At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. 
Registered Nurse (RN). License must be active and unrestricted in state of practice. 
Ability to prioritize and manage multiple deadlines. 
Excellent organizational, problem-solving and critical-thinking skills. 
Strong written and verbal communication skills. 
Microsoft Office suite/applicable software program(s) proficiency. 
Preferred Qualifications 
Certified Professional in Healthcare Management (CPHM). 
Recent hospital experience in an intensive care unit (ICU) or emergency room. 
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

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About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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