Authorization Nurse, RN - 24-178

We're delighted you're considering joining us!At Hill Physicians Medical Group, we're shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.Join Our Team!Hill Physicians has much to offer prospective employees. We're regularly recognized as one of the "Best Places to Work in the Bay Area" and have been recognized as one of the "Healthiest Places to Work in the Bay Area." When you join our team, you're making a great choice for your professional career and your personal satisfaction.DE&I Statement:At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!Job Description:Evaluate authorization requests and authorize, modify or pend per appropriate criteria. Refer authorization requests not meeting criteria to specialty teams according to established medical necessity, benefit and eligibility criteria to assure appropriate, efficient and timely medical care.Job Responsibilities* Review and process urgent and non-urgent authorization requests (via phone and fax) for medical necessity (according to established criteria) and authorize, pend or modify as appropriate.* Obtain additional medical information as necessary from requesting provider.* Communicate with providers and members regarding status of authorization requests.* Collaborate with Medical Directors and other designated physician leaders for making clinical decisions.Required Experience* Active, unrestricted California Licensure: Registered (RN) or Licensed Vocational Nurse (LVN).* Minimum three years clinical nursing experience.* HMO Utilization Management experience preferred.* Excellent verbal and written communication skills.* Ability to work effectively with a variety of customers including physicians, office staff, and members.* Ability to work independently with self initiative and discipline.* Knowledge of ICD-10 and CPT coding.Required Education* High School Diploma/GEDAdditional InformationHill Physicians is an Equal Opportunity Employer