Clinical Review Nurse - Prior Authorization

Position Title : Clinical Review Nurse - Prior Authorization

Work Location : California (Remote)

Assignment Duration : 12 months (Possibility to convert )

Work Schedule : Training 8-5PM PST - 4-6 week course - NO TIME OFF - CAMERA ON 8-5PM PST.

NO OT, Holidays or weekends

Work Arrangement : Remote

Position Summary :

Performs medical necessity and clinical reviews of authorization requests to determine the medical appropriateness of care in accordance with regulatory guidelines and criteria

Background & Context :

• Diverse, supporting team. Key projects for turn around time
• Weekly overview team meetings CAMERA ON (professional environment and attire)
• Monthly 1on1 meet CAMERA ON
• Group chat on teams for any questions

Key Responsibilities :

Qualification & Experience :

Candidate Requirements

Required : Requires Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing and 2 - 4 years of related experience.

Preferred :

Required : RN CA licensure required

Preferred :

Years of experience required : 2-3 years of clinical experience. UM a plus,

Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred.

Knowledge of Medicare and Medicaid regulations preferred.

Knowledge of utilization management processes preferred.

Disqualifiers : Not having a CA RN license, No long pauses in recent work history,

Additional qualities to look for :

Critical thinking / Independent work

Organization / multitasking skills

Microsoft Office Suite product knowledge (Teams, one note, excel and word) / tech savvy