What are the responsibilities and job description for the Prior Authorization Nurse position at Actalent?
Equivalent Experience
Position:
Prior Authorization Nurse
Pay:
$31-35/hr
Shift:
Monday-Friday 8am-5pm
Qualifications:
Bachelor's or Associates degree in Nursing
Must have current state RN license
Must have 2 years of clinical nursing experience (ideally if someone has outpatient or ambulatory or prior managed care experience that would be preferred)
Proficiency with Microsoft office suite specifically filtering within Excel, electronic medical records experience. Need to be comfortable working on computers and working on dual monitors
Job Description:
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
About Actalent:
Actalent connects passion with purpose. Our scalable talent solutions and services capabilities drive value and results and provide the expertise to help our customers achieve more. Every day, our experts around the globe are making an impact. We’re supporting critical initiatives in engineering and sciences that advance how companies serve the world. Actalent promotes consultant care and engagement through experiences that enable continuous development. Our people are the difference. Actalent is an operating company of Allegis Group, the global leader in talent solutions.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
Position:
Prior Authorization Nurse
Pay:
$31-35/hr
Shift:
Monday-Friday 8am-5pm
Qualifications:
Bachelor's or Associates degree in Nursing
Must have current state RN license
Must have 2 years of clinical nursing experience (ideally if someone has outpatient or ambulatory or prior managed care experience that would be preferred)
Proficiency with Microsoft office suite specifically filtering within Excel, electronic medical records experience. Need to be comfortable working on computers and working on dual monitors
Job Description:
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
About Actalent:
Actalent connects passion with purpose. Our scalable talent solutions and services capabilities drive value and results and provide the expertise to help our customers achieve more. Every day, our experts around the globe are making an impact. We’re supporting critical initiatives in engineering and sciences that advance how companies serve the world. Actalent promotes consultant care and engagement through experiences that enable continuous development. Our people are the difference. Actalent is an operating company of Allegis Group, the global leader in talent solutions.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
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