Pre-Authorization Nurse
About The Position
The Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. The Pre-Authorization Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Pre-Authorization Nurse 2 completes medical necessity and level of care reviews for requested services using clinical judgment and refers to internal stakeholders for review depending on case findings.
Requirements
- Must Reside in Oklahoma
- Registered Nurse, compact nursing licence
- 3+ years of clinical nursing experience
- Intermediate to Advanced knowledge of MS Office including Word, Excel, PowerPoint, and Teams in a Windows based environment and an ability to quickly learn new systems and ability to troubleshoot and resolve basic technical difficulties in a remote environment
- Ability to work independently under general instructions and with a team
Nice To Haves
- Health Plan experience working with large carriers
- Previous Medicare/Medicaid experience a plus
- Previous experience in pre-authorization, utilization management, case management, discharge planning and/or home health or rehab
- Experience working with MCG or Interqual guidelines
Responsibilities
- Send and receive telephonic calls averaging 50% communication with providers
- Educate providers on utilization and medical management processes
- Enter and maintain pertinent clinical information in various medical management systems
- Understand own work area professional concepts/standards, regulations, strategies and operating standards
- Make decisions regarding own work approach/priorities and follows direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation.
Benefits
- Paid time off
- holidays
- volunteer time and jury duty pay
- Recognition pay
- 401(k) retirement savings plan with employer match
- Tuition assistance
- Scholarships for eligible dependents
- Parental and caregiver leave
- Employee charity matching program
- Network Resource Groups (NRGs)
- Career development opportunities
- medical, dental and vision benefits
- short-term and long-term disability
- life insurance
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
