Jobs 1 - 13 out of 13 for Prior Authorization Nurse

The Prior Authorization Nurse is responsible for coordinating and obtaining insurance prior authorization for medical services, medications, procedures, durable medical equipment (DME), specialty referrals, and hospital services. Working collaboratively with providers, clinical staff, and insurance ...

Analyze prior authorization requests to determine medical necessity of service and appropriate level of care. Provide recommendations to the medical team, consolidate clinical information, conduct medical necessity reviews, collaborate with Medical Directors, manage high workload, gather clinical in...

Responsibilities include answering inbound phone calls, processing cases and electronic authorizations, loading authorizations, and making follow-up phone calls. Maintaining complete and accurate documentation of all necessary information, involving computer system data entry, data management, and r...

Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards. Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care.

Perform prospective and retrospective utilization reviews for inpatient, outpatient, and specialty services using evidence-based clinical criteria. Review prior authorization requests to determine medical necessity and clinical appropriateness. Evaluate referrals within high-impact specialty areas a...

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 eff...

Review prior authorization requests across a broad range of medical specialties, evaluate medical necessity using clinical records and evidence-based guidelines, apply clinical criteria to support authorization determinations, collaborate with providers and interdisciplinary teams, ensure compliance...

The Nurse Case Manager, Prior Authorization RN is responsible for reviewing and processing prior authorization requests for medical services, ensuring that all clinical criteria and health plan requirements are met. This role involves collaborating with healthcare providers, patients, and internal t...

The Licensed Practical Nurse (LPN) in the clinic setting delivers essential nursing care under the supervision of licensed practitioners or Registered Nurses. This role involves providing direct patient care, assisting with medical procedures, administering medications, performing diagnostic testing...

The Prior Authorization Nurse Case Manager (PACM) promotes quality and cost-effectiveness of medical care by applying clinical acumen to prior authorization specialty referral requests. Responsibilities include reviewing care appropriateness, communicating with providers and staff, maintaining relat...

Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests. Perform telephonic review of prior authorization requests, complete medical necessity and level of care reviews, collabor...

Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members. Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term ...

This position is responsible for performing RN duties using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care. Responsibilities include assessing patients' clinical needs, evaluating medical services, coordinating care implemen...