Apex Systems, the second largest staffing and services firm is looking for a Prior Authorization Nurse to join one of our top Healthcare client in Sacramento, CA! Please see the job requirements below.
Job Title: Prior Authorization Nurse
Company: Apex Systems
Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations.
Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings.
Collaborate with various staff within provider networks and case management team electronically or telephonically to coordinate member care.
Educate providers on utilization and medical management processes.
Provide clinical knowledge and act as a clinical resource to non-clinical team staff.
Enter and maintain pertinent clinical information in various medical management systems
- Active LPN OR RN License
- 2-4 years of nursing experience
- Previous Prior Authorization experience REQUIRED
For over 20 years, Apex has been connecting top professionals with positions at great companies in contract, contract-to-hire, and direct hire positions. We support thousands of job openings per year at companies across North America.
As an employee of Apex, you are valued and part of the Apex family. We provide each employee with an industry-leading benefits program that is designed to support your health, your planning for the future, and your career development.
Apex has resources to support your long-term career and personal development through internal development programs, technical seminars, certification preparation, and certification exam vouchers.
Apex offers several benefits and resources for their employees:
- Health Insurance
- Vision and Dental
- Life Insurance
- Short and Long Term Disability
- 401k options
- Training and Development Programs
To learn more, visit our website: URL blocked - click to apply
Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at 844-463-6178