Clinical Review Nurse - Prior Authorization

Position Summary:

* Review of prior auth requests for Medicaid Line of Business.

* To assist the PA Team reviewing a backlog of requests from providers.

Background & Context:

The PA team works well together - always assisting each other as needed. Teams work closely together and very supportive.

Biweekly team huddles (virtual), and attention to emailed team instructions, proficient in toggling between multiple systems.

To assist the PA Team reviewing a backlog of requests from providers.

Key Responsibilities:

* Review of prior auth requests for Medicaid Line of Business.

* Biweekly team huddles (virtual), and attention to emailed team instructions, proficient in toggling between multiple systems.

* Quality documentation, timely processing of up to 18 authorizations per day on average, team player with positive attitude.

Qualification & Experience:

* Required: Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing and 2 - 4 years of related experience.

* Required: Nursing Licensure.

* Must haves: Computer skills, medical knowledge, care manager or clinical nursing experience.

* Nice to haves: Prior Authorization Nurse, Medical Review Nurse, Appeals Nurse, Utilization Management or Quality Assurance Nurse.