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Prior Authorization Nurse

A-Line Staffing Solutions Sacramento, CA
  • Posted: over a month ago
  • $38 to $39 Hourly
  • Full-Time
  • Benefits: Vision, Medical, Dental

A-Line Staffing is hiring a Registered Nurse (RN) or Licensed Practical Nurse (LPN) for a large insurance client in Sacramento, CA. This position is for immediate consideration for interview, hire, and start date. The ideal candidate will have 2 years of experience within Utilization Review, Utilization Management.

Summary:

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.

Job Responsibilities:

  • 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

Education/Experience:

  • Graduate from an Accredited School of Nursing.
  • Bachelor’s degree in Nursing preferred.
  • Knowledge of healthcare and managed care preferred.
  • Licenses/Certifications: Current State LPN/LVN or RN license
  • 2-4 years of experience as RN/LPN
  • Experience writing AHCCCS denial letters preferred

Pay Rate:
LVN background= $33-35/hr
RN background= $37-39/hr

Contact Aaron Smith at 586-710-7940 for more information.

KEY WORDS: Prior Auth, Prior Authorization, Insurance Verification, Nurse, RN, LPN, Benefit Verification, Denial Letters, Appeals, AHCCCS, Registered Nurse, Health Insurance.

A-Line Staffing Solutions

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