Do you have 2-3yrs of prior authorization experience and are looking for a Hybrid Schedule P rior Authorization Nurse opp
ortunity? Are you available to work a hybrid schedule, 4 days at home and then one day on site in the office in Sunrise? Do you want the chance to advance your career by joining a rapidly growing company in Sunrise FL 33323 area
? If you answered "yes\" to any of these questions - this is the position for you! Daily Responsibilities of a Prior Authorization Nurse:
Requirements for a Prior Authorization Nurse :
- Reviews prior authorization requests for medical necessity and appropriateness, utilizing standardized Review Criteria
- Coordinates with the Medical Director/Physicians for those requests outside of standard Review Criteria.
- Maintains compliance with federal and state guidelines as well as contractual requirements as determined by line of business; this includes coordinating with the Medical Director to ensure requests are processed timely.
- Obtains necessary documentation and ensures completion of assigned caseload by addressing discrepancies and following up until a determination is achieved.
- Serves as a liaison between the Medical Director, physicians and office staff in resolving prior authorization questions, issues and problems; communicates denial determinations to providers when indicated
- Performs evaluation and concurrent monitoring of appropriate utilization of resources including but not limited to durable medical equipment, hospitalizations, home healthcare, infusion services and long term rehabilitation.
- Provides current and timely documentation reflecting department work processes and policy guidelines.
Hours for this Position: Advantages of this position:
- Clear and Active State of FL LPN or RN licensure
- At least two years of utilization review/management experience and a minimum of one year of experience in clinical hospital discharge planning
- Experience in processing prior authorization for medical necessity
- Managed Care Setting Experience is an advantage
- Experience working with InterQual/Milliman Criteria, Florida Medicaid Program and CMS Guidelines.
- Competitive salary of $35 per hour paid weekly!
- Fun and positive work environment
- Supplemental health, life, and dental insurance benefits
Interested in being considered as a Prior Authorization Nurse :
If you are interested in applying to this position, please click Apply Now for immediate consideration or you may send your updated resume to James Wallen at james.wallen @healthcaresupport.com
Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law .
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