RN: Prior Authorization & Care Coordination Expert

Medasource; Phoenix (AZ); On-site; USD 75,000 - 95,000; Full time

Job summary

Medasource is seeking a Prior Authorization RN in Phoenix, AZ to review and process pre-service determinations and concurrent reviews. The role emphasizes adherence to evidence-based guidelines, regulatory standards, and efficient documentation to support cost-effective patient care.

Responsibilities include collaboration with providers and plan stakeholders, ensuring accurate data transfer, and escalation to Medical Directors when guidelines are not clearly met; familiarity with MCG, InterQual,

Qualifications

• Active RN license required in AZ or compact state.
• Outpatient prior authorization for surgeries and DME focus.
• Medicare review experience preferred.
• Experience with guidelines review.
• Familiarity with MCG criteria, CareWebQI and InterQual.

Responsibilities

• Review and process prior authorization requests.
• Collaborate with internal and external stakeholders.
• Transfer patient information for pre-service determinations and care transitions.
• Assess medical necessity and optimize plan outcomes.
• Educate stakeholders on population health management and evidence-based practices.
• Refer requests to Medical Director when guidelines are not met.
• Understand plan documents and authorization criteria.
• Participate in holiday call rotations.

Skills

RN license

AZ license/compact

Outpatient prior auth

Medicare experience

MCG criteria

CareWebQI/InterQual

Guidelines review

Tools

CareWebQI

InterQual

Job description

Medasource is seeking a Prior Authorization RN in Phoenix, AZ to review and process pre-service determinations and concurrent reviews. The role emphasizes adherence to evidence-based guidelines, regulatory standards, and efficient documentation to support cost-effective patient care.

Responsibilities include collaboration with providers and plan stakeholders, ensuring accurate data transfer, and escalation to Medical Directors when guidelines are not clearly met; familiarity with MCG, InterQual,