TELEPHONE CONCURRENT REVIEW NURSE
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.
REGISTERED NURSE QUALIFICATIONS:
- Active RN / Registered Nurse License in Arizona
- Associate Degree Required
- 2+ years of acute care/clinical experience in an inpatient Med/Surg unit
- Managed Care & Utilization Review experience preferred
WHAT’S GREAT ABOUT THIS POSITION FOR A REGISTERED NURSE?
- Full-time opportunity with a major Fortune 100 Managed Care Organization
- Opportunity to step away from the bedside/direct patient care
- Telephonic office-based position; NO REMOTE OPTIONS AVAILABLE
- Competitive benefits!
PLEASE CALL: Alliston Brown / Phone number blocked - click to apply or Phone number blocked - click to apply, EXT 22
registered nurse, RN, acute care, concurrent review, utilization review, utilization management, clinical, telephone, telephonic, retrospective review, case management, insurance, healthcare, managed care, medical surgical, emergency room, intensive care