10bits
Prior Authorization Nurse
10bits, Hamilton, Ohio, United States, 45011
10bits is a Healthcare and Professional Staffing Company. From nursing staffing, temp to hire, and permanent to healthcare contracts, 10bits provides hospitals and medical facilities with high-quality clinical professionals with the highest standards and compliance to provide the best medical care.
Do you have the right skills and experience for this role Read on to find out, and make your application.
Job Title: Prior Authorization Nurse
Job Location: Fully Remote (OH)
Job Type: Contract
Job Duties:* Review and process prior authorization and appeals requests, ensuring compliance with medical necessity guidelines and regulatory standards.* Conduct detailed clinical reviews of medical records and claims, assessing the appropriateness and efficiency of care provided.* Collaborate with healthcare providers and medical directors to gather information, clarify medical details, and make informed decisions on authorizations and appeals.* Document all decisions and processes accurately, maintaining comprehensive records in patient files and organizational systems.* Communicate authorization and appeal outcomes to patients, providers, and relevant stakeholders, providing clear explanations and next steps.* Participate in audits and ensure that all utilization management processes adhere to state, federal, and organizational policies.
Job Requirements:* RN License of OH State* Comfortable toggling between multiple computer systems* Very agile and comfortable in fast-paced environment* Critical thinking skills* good people skills and able to communicate needs* Comfortable with provider interaction* 3 Years Care Manager Experience* 3 Years Clinical Nursing Experience* 4 years Prior Authorization experience
Schedule:* Day shift* 5x8* Monday to Friday
Benefits:* Flexible Schedule
Job Type: Contract
Pay: $30.00 - $43.00 per hour
Benefits:* Flexible schedule
Experience:* Prior Authorization: 4 years (Required)
License/Certification:* RN License of OH State (Required)
Work Location: Remote
Do you have the right skills and experience for this role Read on to find out, and make your application.
Job Title: Prior Authorization Nurse
Job Location: Fully Remote (OH)
Job Type: Contract
Job Duties:* Review and process prior authorization and appeals requests, ensuring compliance with medical necessity guidelines and regulatory standards.* Conduct detailed clinical reviews of medical records and claims, assessing the appropriateness and efficiency of care provided.* Collaborate with healthcare providers and medical directors to gather information, clarify medical details, and make informed decisions on authorizations and appeals.* Document all decisions and processes accurately, maintaining comprehensive records in patient files and organizational systems.* Communicate authorization and appeal outcomes to patients, providers, and relevant stakeholders, providing clear explanations and next steps.* Participate in audits and ensure that all utilization management processes adhere to state, federal, and organizational policies.
Job Requirements:* RN License of OH State* Comfortable toggling between multiple computer systems* Very agile and comfortable in fast-paced environment* Critical thinking skills* good people skills and able to communicate needs* Comfortable with provider interaction* 3 Years Care Manager Experience* 3 Years Clinical Nursing Experience* 4 years Prior Authorization experience
Schedule:* Day shift* 5x8* Monday to Friday
Benefits:* Flexible Schedule
Job Type: Contract
Pay: $30.00 - $43.00 per hour
Benefits:* Flexible schedule
Experience:* Prior Authorization: 4 years (Required)
License/Certification:* RN License of OH State (Required)
Work Location: Remote