Remote RN: Prior Authorization Specialist

Banner Health; Phoenix (AZ); À distance; USD 48 000 - 81 000; Plein temps

Résumé du poste

Banner Health is seeking an experienced RN for Medical Management Services. This remote role supports pre-service determinations, case management, and utilization review across health plans, with responsibilities including outreach to providers and members and accurate documentation.

The position requires AZ residency and offers weekday hours with Saturday rotations. The ideal candidate has prior authorization experience, a solid understanding of care management, and strong communication skills

Qualifications

• RN licensure in the state of practice and ability to work in the assigned state.
• Bachelor’s degree or equivalent experience required.
• Five years of clinical experience preferred.

Responsabilités

• Process health plan pre-service requests and provide case management.
• Perform utilization management duties within required timeframes.
• Coordinate care and communicate with providers, members, and vendors.
• Document all interventions accurately in the medical record.

Connaissances

Care coordination

Utilization management

Research and data lookup

Formation

RN licensure

Bachelor’s degree or equivalent experience

Outils

CMS

Noridian

Optum360 Encoder Pro

Description du poste

Banner Health is seeking an experienced RN for Medical Management Services. This remote role supports pre-service determinations, case management, and utilization review across health plans, with responsibilities including outreach to providers and members and accurate documentation.

The position requires AZ residency and offers weekday hours with Saturday rotations. The ideal candidate has prior authorization experience, a solid understanding of care management, and strong communication skills