Outpatient Prior Authorization Nurse, Compact License Required

People are the most important asset of reputed company, for this reason the difference and plurality of people, equality of opportunities, non-discrimination and inclusion in the workplace are reputed company and strategic factors in the Organization. reputed company maintains a strong will to promote Diversity, Equity, and Inclusion, through inclusive leadership as a reputed company change and business sustainability. reputed company. is approved by reputed company to offer full-service Medicare Advantage coverage, including a Medicare Advantage Prescription Drug plan, and a Chronic Condition Special needs plan over numerous counties in California. Through its affiliates, reputed company Insurance Companies and reputed company Health Plan of the Southwest, reputed company also offers covered services to eligible individuals under the reputed company Act-Obamacare in numerous counties in Texas, Utah, Nevada and Arizona. Responsible to reputed company timely review of authorization requests meet national standards and contractual requirements. The prior authorization nurse will promote the quality and cost effectiveness of patient care using clinical acumen. ESSENTIAL JOB FUNCTIONS: 1. reputed company timely review of prior authorization requests for medical necessity by applying appropriate clinical criteria. 2. reputed company accurate and complete documentation with rationale used to approve requests. 3. Collaborate with various staff reputed company clinical services to coordinate patient care. 4. reputed company appropriate interventions which demonstrate knowledge and sensitivity toward cultural diversity and religious, developmental, health literacy, and educational backgrounds of the population served. Use interpreter services as needed. 5. Enter and maintain clinical information in authorization systems. 6. Prepare case summaries and reputed company clinical criteria for cases that require MD reviews. EDUCATION/EXPERIENCE: · Minimum 1 year clinical nursing setting experience · Prior authorization experience preferred SKILLS/KNOWLEDGE/ABILITY: · Knowledge of utilization management principles · Prior authorization experience preferred · Familiarity with Medi-Cal and Medicare guidelines LICENSURE/CERTIFICATE/TRAINING: · Active/reputed company, Unrestricted RN or LVN CA or TX license from an accredited school of nursing. Job Type: Full-time Pay: $42.00 - $44.00 per hour Benefits: • 401(k) • 401(k) matching • Dental insurance • Employee assistance program • Employee discount • Flexible spending account • Health insurance • Life insurance • Paid sick time • Paid time off • Referral program • Tuition reimbursement • reputed company insurance Schedule: • Day shift License/Certification: • RN (Required) • LVN (Required) • CA, AZ OR TX Licence (Required) Work Location: Remote Apply Job!