Utilization Review Nurse (RN/LVN) – Prior Authorization

Healthcare Support Staffing; Columbus (OH); On-site; USD 65,000 - 85,000; Full time

Job summary

A national healthcare recruiting firm is looking for a candidate with inpatient nursing experience in Columbus, Ohio. You will be responsible for assessing services to ensure optimal outcomes and compliance with regulations, analyzing clinical requests, and conducting prior authorization reviews. The ideal candidate should have 2 years of inpatient nursing, familiarity with Utilization Management, and experience with ICD10 and CPT coding. Interested candidates should reach out to apply.

Qualifications

• 2 years inpatient nursing experience in a hospital environment (Med-Surg, ER).
• Familiarity with Utilization Management protocols required for elective vs urgent requests.
• Experience with provider claims, appeals, and denials processes.
• 6+ months experience with Interqual guidelines.
• 6+ months experience in medical coding (ICD10 and CPT/HCPCS).

Responsibilities

• Assess services for members to ensure optimum outcomes and compliance.
• Analyze clinical service requests against evidence-based guidelines.
• Conduct prior authorization reviews to determine financial responsibility.

Skills

Inpatient nursing experience

Utilization Management expertise

Experience with prior authorization

Coding proficiency with ICD10 and CPT/HCPCS

Clinical analysis skills

Job description

A national healthcare recruiting firm is looking for a candidate with inpatient nursing experience in Columbus, Ohio. You will be responsible for assessing services to ensure optimal outcomes and compliance with regulations, analyzing clinical requests, and conducting prior authorization reviews. The ideal candidate should have 2 years of inpatient nursing, familiarity with Utilization Management, and experience with ICD10 and CPT coding. Interested candidates should reach out to apply.