RN Prior Authorization

Healthcare Support Staffing; Waltham (MA); On-site; USD 41,328; Full time

Benefits offered by this job

Competitive salary

Medical benefits

Positive work environment

Job summary

A national healthcare recruiting firm is seeking an experienced RN Prior Authorization in Waltham, MA. This position requires 2+ years of clinical nursing experience and knowledge in Prior Authorization. Key responsibilities include reviewing authorization requests, collaborating with providers, and managing care processes. The job offers a starting pay of $30 per hour alongside benefits like medical, dental, and vision. If interested, please contact our recruiting consultant for more details.

Qualifications

• 2+ years of clinical nursing experience.
• Prior Authorization experience from a managed care company or clinical setting.

Responsibilities

• Apply clinical acumen to prior authorization requests.
• Perform telephonic reviews of authorization requests.
• Complete medical necessity reviews using clinical judgment.
• Collaborate with staff to coordinate member care.
• Educate providers on medical management processes.

Skills

Clinical nursing experience

Prior Authorization experience

Job description

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Job Description

Are you an experienced RN Prior Authorization looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions – this is the position for you!

Daily Responsibilities:

• 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 determinations

• 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 member care

• Educate providers on utilization and medical management processes

Hours for this Position:

• Pay rate starts at $30 per hour

Advantages of this Opportunity:

• Competitive salary, negotiable based on relevant experience

• Benefits offered, Medical, Dental, and Vision

• Fun and positive work environment

Qualifications

• Candidates must have a car- mass transportation in Boston doesn’t go to Waltham

• 2+ years of clinical nursing experience

• Some sort of Prior Authorization experience from either another managed care company or clinical setting

Additional Information

Interested in being considered?

If you are interested in applying to this position, please contact (Katleen Angala, 321-445-8243) and click the Green I’m Interested Button to email your resume.