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Prior Authorization Nurse

Bedford, NH 03110

Post Date: 05/22/18 Job ID: 45267 Industry: Certified Nursing Assistant

This Fortune 500 client is a nation-wide leader in the healthcare services field and they pride themselves on their ability to provide a wide range of government sponsored healthcare programs; including a variety of insurance solutions. Currently, they are seeking a Prior Authorization Nurse to 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.

Position: Direct Hire

Location: Bedford, New Hampshire

Similar Positions: Registered Nurse

Responsibilities of the Prior Authorization Nurse:
  • Follow company guideless and polices to approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations
  • Determine level of medical necessity and care reviews for requested services using clinical judgement
  • Refer to Medical Directors for review depending on case findings
  • Coordinate member care by collaborating with various staff members within provider networks and case management team
  • Educate providers on utilization and medical management processes
  • Be a leader to non-clinical staff by providing clinical knowledge when needed
  • Enter and maintain important clinical information

Requirements of the Prior Authorization Nurse:
  • Graduate from an Accredited School of Nursing; Bachelor s degree preferred
  • Must have a current state LPN, LVN, or RN license
  • Must have 2+ years of clinical experience
  • Knowledge of healthcare and managed care preferred
  • Applicants must be currently authorized to work in the United States on full-time basis

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