Location: 100% Remote, Compact license - REQUIRED, Can source nationwide. Make sure they candidates are clinically licensed in all 5 states indicated Below.
REMOTE- NC
REMOTE- DE
REMOTE- NH
REMOTE- NJ
REMOTE -SC
SHIFT: Mon – Fri 8am-5pm EST , No OT
Duration: 6 months
Description: Job Profile Summary: Review Prior Authorization requests for various service types for the Medicaid LOB
Team member will receive an assignment that is LIVE (excel spreadsheet)
Team member will process various authorization service types using clinical coverage policies or InterQual.
Team member will submit any requests that do not meet criteria to second level review (MD) for a determination.
12-15 nurse reviews per day
| Candidate Requirements |
| Education/Certification | Required: Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing | Preferred: |
| Licensure | Required: LPN COMPACT | Preferred: RN Compact |
Years of experience required: 3+ related experience
Disqualifiers: No Compact LPN or RN, No Prior Auth review experience
Additional qualities to look for: Organized team player who is willing to learn in a fast pace environment |
- Top 3 must-have hard skills stack-ranked by importance
| 1 | Computer literacy |
| 2 | Prior experience with prior authorization |
| 3 | Prior experience using state clinical coverage policies (Medicaid) |