Clinical - Clinical Review Nurse - Prior Authorization - J00927

Remote - Oregon

Duration : 3 months

Schedule : Work Mon-Fri 8a-8p PST with occasional weekend / holiday work with team rotating schedule

Job Description : Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage. Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care. Will review Up to 20 auth reviews per day.

Requirements : Must possess a OR license and at least 2 years of Prior Authorization experience. Typical Day in the Role

• Daily schedule & OT expectations
• Typical task breakdown and rhythm
• Interaction level with team
• Work environment description

Work Mon-Fri 8a-8p PST with occasional weekend / holiday work with team rotating schedule. Compelling Story & Candidate Value Proposition

Remote; Has the ability to review both PA and IP requests

One for all; All for one; All hands on deck

Remote; great team

Must possess at least 2 years of Prior Authorization experience Candidate Requirements- LPN / RN in Nursing; Must have at least 2 years prior experience in Prior Authorization with an Insurance company Education / Certification Required : LPN / AS RN Preferred : RN Licensure Required : i.e. RN, LPN Preferred :

Must haves : 2 years experience with PA or IP auth reviews

Nice to haves : Willingness to learn

Positive attitude

Performance indicators :

Up to 20 auth reviews per day

1 Previous experience with prior auth 2 Must be a team player that works well independently 3 Must be willing to work a flexible schedule of 1 weekend a month, a few holidays per year