Prior Authorization Registered Nurse - Remote
Company: Vivo HealthStaff Inc.
Posted on: September 19, 2022
(Only QUALIFIED Healthcare Professionals accepted) Other - Vivo
HealthStaff is hiring a Prior Authorization Registered Nurse for a
health plan based in Southern California.
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.
Perform telephonic review of prior authorization 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
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 case
management team electronically or telephonically to coordinate
Educate providers on utilization and medical management
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
- BSN in Nursing
- CA Registered Nurse License
- Located within 50 miles of Los Angeles, CA
- 3 years of experience in Prior Authorization-Utilization
Keywords: Vivo HealthStaff Inc., Riverside , Prior Authorization Registered Nurse - Remote, Healthcare , Riverside, California
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