Job Description

Job Description

Immediate need for a talented Prior Auth RN/ Clinical Review Nurse . This is a 03+months contract opportunity with long-term potential and is located in Charlotte, NC (Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID: 25-82861

Pay Range: $35 - $38/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria
• Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care
• Coordinates as appropriate with healthcare providers and interdepartmental teams, to assess medical necessity of care of member
• Escalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of care
• Assists with service authorization requests for a member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities
• Collects, documents, and maintains all member’s clinical information in health management systems to ensure compliance with regulatory guidelines
• Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to members
• Provides feedback on opportunities to improve the authorization review process for members
• Performs other duties as assigned
• Complies with all policies and standards

Key Requirements and Technology Experience:

• Key Skills; RN
• Prior Auth
• Utilization management
• Must haves: 2 years experience with PA or IP auth reviews
• Nice to haves: Previous experience with NC State Criteria/ InterQual Criteria
• Education/Certification ; Required: LPN/AS RN
• Licensure; Required: i.e. RN, LPN

Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

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