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Prior Authorization Nurse

A-Line Staffing Solutions Bridgewater Full-Time
$70,000.00 - $74,500.00 / year
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 A-Line Staffing is now hiring Registered Nurses for a Prior Authorization Nurse opportunity in Bridgewater, Massachusetts. This Prior Authorization Nurse position is with a Fortune 10 company and has career growth potential. This would be full time / 40+ hours per week.

 

Prior Authorization RN Benefits:

  • Full benefits available after 90 days: Medical, Dental, Vision, Life, Short-term Disability
  • 401k after 1 year of employment: With employer match and profit sharing
  • Wellness Program: Now including FITNESS benefits!
  • GREAT Hours! Monday through Friday, 40 hours per week, No Weekends
  • Competitive Pay Rate!

Prior Authorization Nurse Essential Functions:

  • Develops and manages new enrollee transitions and those involving a change in provider relationships.
  • Develops and implements transition plans, as indicated, to ensure continuity of care.
  • Negotiates and documents single case agreements according to the company's procedures.
  • Reviews planned, in process, or completed health care services to ensure medical necessity and effectiveness according to evidence-based criteria.
  • Proposes alternatives when the requested services do not meet medical necessity criteria or are outside the contracted network. In conjunction with providers and facilities, identifies, develops and monitors discharge plans. Collaborates with the Care Coordination Team to implement support for transitions in care. Facilitates timely sharing of enrollee’s clinical information (such as previous treatment, medications, and planned care) in order to promote continuity of care.
  • Provides information to enrollees, providers, and internal staff regarding covered and non-covered benefits, community resources, agency programs, and company policies and procedures and criteria.

Prior Authorization Nurse Minimum Qualifications:

  • Associate’s Degree in Nursing or higher
  • RN License in MA REQUIRED
  • Minimum of 3+ years of experience conducting utilization management according to medical necessity criteria REQUIRED
  • 3 years’ experience post degree in a clinical, psychiatric and/or substance abuse health care setting PREFERRED
  • Able to demonstrate the ability to quickly develop an alliance with providers via telephone.

 

 

If interested, please apply to this job posting right away. I look forward to hearing from you!
Bryan Roy
(877) 782-3334 ext. 264
broy@alinestaffing.com

Key Words: Prior Authorization, Clinical Review, Registered Nurse, Utilization Management, Utilization Review, Utilization Manager

Recommended skills

Utilization Management
Health Care
Nursing

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Prior Authorization Nurse
$70,000.00 - $74,500.00 / year
Estimated Salary: $87K
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A-Line Staffing began in 2004 with just two of us – a father and son with 30 combined years of experience started the company out of a basement in Warren, Michigan. We started our company with just one placement, and continue to build the company and our relationships – one placement at a time.

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