Spectraforce Technologies
Clinical Review Nurse - Prior Authorization
Spectraforce Technologies, Kansas City, Missouri, United States, 64101
Job Title: Clinical Review Nurse - Prior Authorization
Duration: 05 Months
(Possible extension )
Location: Remote - MO
Monday - Friday (8 hours)
Walk me through the day-to-day responsibilities of this the role and a description of the project (Outside of Workday JD):
Reviewing authorization requests
Utilizing evidence-based criteria and making a medically necessary determination.
Outreach calls to providers to request additional details if applicable.
They will not be completing any calls to members.
Required Skills/Experience:
Preferred Skills/ Experience:
1.ICU, Medical Surgical background, bedside experience (Home health nurses)1.Medicare experience ( Utilization Management with Medicare)
2.Utilization Review (Prior Authorization)2.CCM Certification
3.Acute Care3.ACLS Certification
Education Requirement:Bachelor's with RN or RN without Bachelors is okay tooEducation Preferred:
Software Skills Required:TruCare is the system the team uses so if they have experience it is beneficial. Microsoft Office Systems
Required Certifications:RN is what the team is really looking for (If the person has an RN license without a bachelors, they are okay)
LPN - Licensed Practical Nurse - State Licensure required Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria.Required Testing:n/a
Duration: 05 Months
(Possible extension )
Location: Remote - MO
Monday - Friday (8 hours)
Walk me through the day-to-day responsibilities of this the role and a description of the project (Outside of Workday JD):
Reviewing authorization requests
Utilizing evidence-based criteria and making a medically necessary determination.
Outreach calls to providers to request additional details if applicable.
They will not be completing any calls to members.
Required Skills/Experience:
Preferred Skills/ Experience:
1.ICU, Medical Surgical background, bedside experience (Home health nurses)1.Medicare experience ( Utilization Management with Medicare)
2.Utilization Review (Prior Authorization)2.CCM Certification
3.Acute Care3.ACLS Certification
Education Requirement:Bachelor's with RN or RN without Bachelors is okay tooEducation Preferred:
Software Skills Required:TruCare is the system the team uses so if they have experience it is beneficial. Microsoft Office Systems
Required Certifications:RN is what the team is really looking for (If the person has an RN license without a bachelors, they are okay)
LPN - Licensed Practical Nurse - State Licensure required Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria.Required Testing:n/a