The Pre-Authorization Nurse 1 reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. The Pre-Authorization Nurse 1 work assignments are often straightforward and of moderate complexity.
The Pre-Authorization Nurse 1 completes medical necessity and level of care reviews for requested services using clinical judgment, and refers to internal stakeholders for review depending on case findings. Educates providers on utilization and medical management processes. Enters and maintains pertinent clinical information in various medical management systems. Understands own work area professional concepts/standards, regulations, strategies and operating standards. Makes decisions regarding own work approach/priorities, and follows direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation.
- Active LPN/RN license in the state of Florida and ability to be licensed in multiple states without restrictions.
- A minimum of two years varied clinical nursing in acute care such as Med Surg, critical care, or related inpatient experience
- Proficient with MS Office products including Word, Excel and Outlook
- Ability to work independently under general instructions and with a team
- Must be willing to commute daily to an office locatio in Tampa Forida
- Must be willing to work Monday-Saturday for a total of 40 hours per week (8 hour shifts) 8:00AM-5:00PM and later as business needs.
- Health Plan experience working with large carriers
- Previous Medicare/Medicaid experience a plus
- Previous experience in utilization management, case management, discharge planning and/or home health or rehab
- Experience working with MCG or Interqual guidelines
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Scheduled Weekly Hours
To Apply to this Job, Please go to the website address given in the source.