Registered Nurse II

HireTalent; Morris Plains (NJ); Remote; USD 70,000 - 85,000; Full time

Job summary

A leading company is seeking a Licensed RN for a virtual role focused on clinical criteria prior authorization. Responsibilities include crafting authorization requests and guiding clients through the process. Candidates need strong communication and organizational skills, along with proficiency in Microsoft Office, particularly Excel.

Qualifications

• Demonstrates 'Team Player' and collaborative skills.
• Communicates effectively within teams.
• Ability to comprehend responsibilities and articulate the importance of assigned tasks.

Responsibilities

• Responsible for clinical criteria prior authorization setup.
• Creates questions for prescribers that lead to approvals or denials.
• Develops operational controls to maximize service levels.

Skills

Communication

Microsoft Office

Organization

Self-Driven

Collaboration

Education

Licensed RN

Job description

No direct patient care. This is a virtual position.
Responsible for clinical criteria prior authorization setup, which takes client clinical policy requirements and creates the prior authorization request sent to prescribers. This could include questions such as (but not limited to) is the patient 18, does this patient have , has the patient tried and failed these alternative medications etc. The creation of questions and answers along with other additional configuration will allow prescribers to answer questions leading to either an approval or denial. Clinicians are also responsible for creating and coding denial rationales sent to prescribers and patients. The system leveraged for this coding is a web-based platform proprietary to Client, and selected contractor will be trained on how to leverage this platform. Additionally, the individuals should have strong skills with Microsoft office, particularly excel.
Configuration support will be for both pharmacy and medical criteria and will require good creative problem-solving skills to ensure appropriate setup to meet client needs and maximum operation efficiency.
Consultative support in explaining setup and system requirements might be needed if discussing criteria setup with other internal Client business partners. An individual with strong and effective communication skills is highly desired.

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Communication, MicroSoft Office, Organization, Self-Driven, Collaboration Qualifications:(1) Demonstrates 'Team Player' and collaborative skills within internal and external teams(2) Takes risks by thinking strategically about problems and challenges within their domain(3) Communicates effectively within peer group and subordinate groups(4) Holds oneself accountable for designated client relationships and the delivery of requests associated to service.(5) Capable of & develops robust operational controls to maximize service levels.(6) Able to identify the needs of clinical system or process changes to help enhance service levels.(7) Ability to comprehend and articulate the importance of assigned responsibilities and controls.(8) Able to mitigate concerns of business partners within direct scope of responsibility.(9) Able to clearly communicate directly with clients when providing consultative services.
3 Non-Negotiable Skills:
- Licensed RN
- Good communication
- Attention to detail