Job Description

Key Responsibilities:

Evaluate the medical necessity of requests based on established criteria.
Enhance the quality and cost-effectiveness of care by applying clinical expertise and relevant policies to prior authorization requests.
Collaborate with healthcare providers and the authorization team to ensure timely review and approval of services, ensuring members receive the care they need.
Coordinate with healthcare providers and internal teams to assess the medical necessity of care for members.
Escalate prior authorization requests to Medical Directors when needed to ensure appropriate care decisions.
Assist with authorization requests related to transfers or discharge plans to facilitate smooth transitions between levels of care and facilities.
Collect, document, and manage clinical information in health management systems to ensure compliance with regulatory guidelines.
Provide education to providers and internal teams on utilization processes to promote high-quality, cost-effective care.
Offer feedback to improve the authorization review process and enhance member care.
Training:

Participate in a 4-week corporate training program, followed by 1:1 training with a team nurse.
Previous Experience:

Experience in Prior Authorization or Utilization Review is required.
Previous remote work experience is preferred.
Registered Nurse Requirements:

Must reside in Arizona.
Current Registered Nurse license in Arizona.
Prior experience working with Health Plans is advantageous.
Employment Type: Full-Time
Salary: $ 40.00 Per Hour

Job Tags

Hourly pay, Full time, Work experience placement,

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