Clinical Review Nurse- Prior Authorization

Pacer Group; United States; Remote; USD 40,000 - 44,000; Full time

Job summary

A leading company in healthcare staffing is seeking a Clinical Review Nurse for Prior Authorization roles. This remote position involves reviewing Medicaid prior authorization requests and requires skills in nursing and medical knowledge. Candidates should have a strong background in healthcare management and computer skills. An entry-level position is available with competitive compensation and room for growth.

Qualifications

• 2-4 years of related experience required.
• Experience in care management or clinical nursing.
• Prior authorization or medical review experience preferred.

Responsibilities

• Review prior authorization requests for Medicaid Line of Business.
• Participate in virtual team huddles and follow team instructions.
• Assist in reviewing backlog of requests from providers.

Skills

Computer skills

Medical knowledge

Prior authorization experience

Education

Graduate from an Accredited School of Nursing

Bachelor’s degree in Nursing

Job description

Clinical Review Nurse- Prior Authorization

Clinical Review Nurse- Prior Authorization

Title - Clinical Review Nurse- Prior Authorization

Duration - 6 months

Shift - 8 am- 5 pm

Location - Remote OH

Pay rate: XX40-42.00XX

Responsibilities

• BHP Prior Authorization Clinical Review Nurse
• Biweekly team huddles (virtual), and attention to emailed team instructions, proficient in toggling between multiple systems
• Review of prior auth requests for Medicaid Line of Business.
• To assist the PA Team reviewing a backlog of requests from providers
  
  

Must Haves

• Computer skills, medical knowledge,
• Care manager or clinical nursing experience
  
  

Nice To Haves

• Works well for this role: Prior Authorization Nurse, Medical Review Nurse, Appeals Nurse, Utilization Management or Quality Assurance Nurse
  
  

Performance Indicators

• (Meet expectations) Quality documentation, timely processing of up to 18 authorizations per day on average, team player with positive attitude
  
  

Top 3

• Computer skills
• Prior authorization previous experience
• Medical knowledge
  
  

Education

• Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Staffing and Recruiting

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