Prior Authorization Nurse 1
7990 Interstate 10 San Antonio, TX 78230
Now hiring for a Top Healthcare / Managed Care company in San Antonio whom are in need of several experienced Prior Authorization Nurse to become a part of the team, for an onsite position.
Active: RN License Required
- Pay Rate: $33 per hour
- Hours: Full time – Monday - Friday 40 hour 8: 00 a.m. - 5: 30 p.m.
Prior Authorization Nurse Job Description:.
- Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews.:
- Perform onsite review of emergent/urgent and continued stay 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 determination
- 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 discharge planning team electronically, telephonically, or onsite to coordinate member care
- Conduct discharge planning
- 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
- Graduate from an Accredited School of Nursing.
- Bachelor’ s degree in Nursing preferred
- Current state’ s RN license.
- 0-2 years of experience
- Managed Care experience plus
- Strong Clinical knowledge with Prior Auth Experience.
Please contact Damian Sroka by applying directly.