Prior Authorization Nurse 2

Sacramento, CA 95833

Posted: 07/18/2019 Category: Registered Nurse Job Number: 29770

Now hiring for a Top Healthcare / Managed Care company in Sacramento, CA whom are in need of several experienced Prior Authorization Nurse to become a part of the team, for an onsite position.

Active: LPN / LVN or RN License Required
  • Pay Rate: LVN background= $33-35/hr RN background= $37-39/hr
  • 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

 

Education/Experience:
  • Graduate from an Accredited School of Nursing.
  • Bachelor’ s degree in Nursing preferred
  • Current state’ s LPN/LVN or RN license.
  • 0-2 years of experience

 

Required:
  • Education/Experience: Graduate from an Accredited School of Nursing. Bachelor’ s degree in Nursing preferred. 2+ years of clinical nursing experience and 1+ years of utilization management experience in a managed care setting.
  • Acute care experience preferred. Knowledge of utilization management principles and healthcare managed care.
  • Experience with medical decision support tools (i.e. Interqual, NCCN) and government sponsored managed care programs

Please contact Damian Sroka by applying directly.

Managed Care, Health Plan, Health Insurance, Case Manager, Care Manager, Utilization Review, Utilization Management, STARS, HEDIS, Complex Case Management, CCM, Certified Case Manager, NCQA, URAC, CMS, Medicare, Medicaid, HMO, RN, BSN, MSN, Registered Nurse, Quality Assurance, Quality Improvement

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