Prior Authorization Nurse, FT Days (54591)
About The Position
The Prior Authorization Nurse’s primary responsibilities are to perform the review requests for service authorizations in order to monitor continuity and coordination of care and to assist in the utilization of appropriate services. These reviews include selected specialties, medical treatments and services, elective hospital admissions, rehabilitative and ancillary services. Assist the complex cases and internal process development and interact closely with the Medical Directors and Prior Authorization Representatives to direct appropriate utilization and data captured.
Requirements
- Three (3) years of clinical nurse experience as Registered Nurse (RN) required.
- Experience in Emergency Room, Urgent Care, Clinic or hospital/provider office nursing.
- Knowledge of government and third-party payer reimbursement methodology.
- Healthcare operations experience, particularly in acute care hospital setting.
- Current RN License to practice in the State of Texas.
- Current Basic Life Support (BLS).
- Valid drivers license/proof of insurance.
- Bachelors of Science in Nursing.
- Must be able to work independently and possess strong clinical skills.
- Detail oriented, able to function under pressure and multi-task.
- Excellent communication skills, verbal and written.
- Knowledge of computers and all other office equipment.
- Working knowledge of software applications (i.e. MS Office, Word, Excel, etc.).
- Knowledge of Medicare regulations and federal
- Strong service orientation and professionalism.
- Must possess critical thinking and problem solving skills.
- Knowledge of CPT, HCPCs and ICD10 coding principles.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
251-500 employees
