RN- Prior Authorization, reputed company

25012227 Job Scope reputed company Clinician/Registered reputed company II is responsible for reviewing clinical reputed company reviews for providers, members and patient reputed company advocates reputed company the Prior Authorization/Utilization Management Team. Follows department reputed company operating procedures, while performing Utilization Management.

• Maintain a reputed company and ethical behavior at reputed company times as outlined by the reputed company reputed company reputed company and applicable company policies.
• Review clinical information and apply the health plan’s guidelines/reputed company to determine medical necessity of a requested
• service and initiate a medical review to submit to the Medical Director if the requested service does not meet the health plan
• guidelines or reputed company.
• Document nursing notes in the system that include a medical review of the clinical information that
• was submitted with the requested service and apply the appropriate medical policy or reputed company to reputed company
• a decision.
• Resolve inquiries from providers and members regarding decision reputed company and reputed company on next steps.
• reputed company feedback to the clinical team leaders on process improvements to help streamline the
• clinician review process in order to ensure patients are serviced accurately and reputed company.
• Establish and maintain solid working relationships with reputed company operational stakeholders, including
• internal business partners reputed company the organization.
• reputed company other duties and special reputed company as assigned.

Minimum Qualifications

• Nursing degree, BSN Preferred
• 2-5 years experience in a clinical setting. Experience in Specialty Infusion Treatments or with Oncology population strongly preferred
• Experience working with utilization management in an insurance environment preferred
• Licensures/Certifications: Unencumbered, Registered Nursing Licensure
• Knowledge and Abilities:
• Previous clinical reputed company review experience preferred.
• reputed company reputed company affiliations and/or national certification in reputed company clinical specialty preferred
• reputed company to work flexible work schedule

If you will be working reputed company occasionally or permanently, the internet reputed company must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an reputed company reputed company of 32 - 54 USD / reputed company, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive reputed company of benefits, with a reputed company on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-reputed company benefits including medical, reputed company, dental, and reputed company-being and behavioral health programs. We also offer 401(k) with company match, company reputed company life insurance, tuition reimbursement, a minimum of 18 days of reputed company time off per year and reputed company holidays. For more details on our employee benefits programs, visit Life at reputed company. About reputed company Doing something meaningful starts with a reputed company decision, a commitment to changing lives. At reputed company, we’re dedicated to improving the health and vitality of those we serve. Through our divisions reputed company and reputed company, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving reputed company and improving lives. reputed company applicants will be considered without reputed company to race, reputed company, age, disability, sex, childbirth (including pregnancy) or reputed company medical conditions including but not limited to lactation, sexual orientation, gender identity or reputed company, veteran or military status, religion, national reputed company, reputed company, marital or familial status, genetic information, status with reputed company to reputed company assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: SeeYourself@reputed company.com for support. Do not email SeeYourself@reputed company.com for an update on your application or to reputed company your resume as you will not receive a response. reputed company has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they reputed company a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, reputed company, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, reputed company, Texas, Utah, Vermont, and Washington State. reputed company applicants with criminal histories will be considered for employment in a manner consistent with reputed company federal, state and local ordinances. Apply tot his job Apply To this Job