Sorry, this job is no longer accepting applications. See below for more jobs that match what you’re looking for!

Prior Authorization Nurse

Expired Job

Carenational Tampa , FL 33607

Posted 5 months ago

Prior Authorization Nurse (LPN) - Health Plan
Tampa, FL
This is a full-time, benefits available, CONTRACT opportunity, expected to last 6 months, or longer!

Prior
Authorization Nurse

Job Summary:

  • The Prior Authorization Nurse is to promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization specialty referral requests.
  • The Prior Authorizations Nurse ensures that prior authorization requests are completed in a timely fashion to meet contractual requirements and that all reviews are conducted using nationally recognized and evidence based standards.
  • Evaluates the pre-service authorization request received for scheduled inpatient admissions, ambulatory surgeries, outpatient services, and out of network providers.
  • As needed, they will forward requests to the appropriate physician or medical director with recommendations for other determinations, ensuring that the member is receiving the appropriate quality care in a preferred setting, while making sure regulatory guidelines are followed.
Prior Authorization Nurse Background:
  • Current, valid, and unrestricted state Registered Nurse (R.N.) or License Practical Nurse (L.P.N.) license.
  • 2 years acute care clinical nursing experience is required.
  • Requires 1-2 years of recent experience in Pre Certifications, Utilization Review orCase Management at a hospital or health plan or other managed care organization (HMO/TPA/IPA/etc).
  • Knowledge of guidelines for Medicaid/Medicare and related state programs is required.
  • Experience using InterQual criteria for medical necessity, setting and level of care, and concurrent patient management.
  • Computer skills to include Microsoft Word, Excel, database use, and basic data entry.
#CLINICAL
upload resume icon
See if you are a match!

See how well your resume matches up to this job - upload your resume now.

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Prior Authorization Representative

Morgan Stephens

Posted Yesterday

VIEW JOBS 1/17/2019 12:00:00 AM 2019-04-17T00:00 <strong>About us:</strong><br /> Morgan Stephens represents the nation’s top healthcare systems offering the highest compensation and benefits to our top candidates.   We are created and managed by experienced industry professionals in healthcare. As a leading provider of contract, contract to perm, and direct placement recruiting services to healthcare organizations throughout the United States, we have successfully served the needs of our employees and clients by placing thousands of quality healthcare professionals into organizations seeking top talent.<br />  <br /> <strong>Open Position:</strong><br /> We are currently seeking healthcare professionals for a Patient Authorization Representative position. This position will provide daily pre-certification billing activities and communications between customers and insurance companies. Patient Authorization Representatives regularly obtain pre-certifications from insurance companies for services to be rendered at customer outpatient facilities for further patient treatment and project management planning.<br /> <br /> JOB RESPONSIBILITIES:<br /> Checks eligibility<br /> Verifies benefits<br /> Obtains and enters data into systems<br /> Processes requests<br /> Clerical support<br /> Ensures services provided are of the highest quality available while remaining cost-effective<br /> <br /> JOB REQUIREMENTS:<br /> Medical Terminology<br /> Data Entry Skills<br /> 35+ WPM score<br /> High School Diploma/Or Equivalent<br /> <br /> <strong>For More Information:</strong><br /> Visit <a href="http://www.morganstephens.com/">www.morganstephens.com</a><br /> Twitter: <a href="http://www.twitter.com/morganstephens0">www.twitter.com/morganstephens0</a><br /> Instagram: <a href="http://www.instagram.com/morganstephens0/">www.instagram.com/morganstephens0/</a><br /> Facebook: <a href="http://www.facebook.com/MorganStephens0">www.facebook.com/MorganStephens0</a><br /> Email: <a href="mailto:info@morganstephens.com">info@morganstephens.com</a><br /> <br /> <strong>Morgan Stephens ofrecemos reclutadores que hablan Espanol</strong> Morgan Stephens Tampa FL

Prior Authorization Nurse

Expired Job

Carenational