Spectraforce Technologies
Clinical Review Nurse - Prior Authorization
Spectraforce Technologies, Houston, Texas, United States, 77246
Title: Clinical Review Nurse - Prior Authorization
Duration: 03 Months (Contract to Hire)
Location: Remote - Nationally Sourced
Shift:
Monday - Friday. (Can be EST (highly preferred), CST (second preference). (We can negotiate schedules. If someone is willing to work weekends that would be in the future. On the weekends we have a skeleton crew and generally do not schedule new staff because there is limited support.)
Responsibilities:Reviewing authorization requestsUtilizing 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.Productivity requirement will be discussed upon hire.
First day:
After completing IT training there will be training with teams learning and development team (~4-week course)Will be learning about the medical management system in which they will be working withinShadowing with fellow team member / preceptors (RN) to ensure they are equipped with all information and materials.
Internal/External Groups with which the Candidate will interface:
Required Skills/Experience:
Preferred Skills/ Experience:
ICU, Medical Surgical background, bedside experience (Home health nurses)1.Medicare experience (Utilization Management with Medicare)
Utilization Review (Prior Authorization)2.CCM Certification
Acute Care3.ACLS Certification
Education Requirement:Bachelors 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: 03 Months (Contract to Hire)
Location: Remote - Nationally Sourced
Shift:
Monday - Friday. (Can be EST (highly preferred), CST (second preference). (We can negotiate schedules. If someone is willing to work weekends that would be in the future. On the weekends we have a skeleton crew and generally do not schedule new staff because there is limited support.)
Responsibilities:Reviewing authorization requestsUtilizing 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.Productivity requirement will be discussed upon hire.
First day:
After completing IT training there will be training with teams learning and development team (~4-week course)Will be learning about the medical management system in which they will be working withinShadowing with fellow team member / preceptors (RN) to ensure they are equipped with all information and materials.
Internal/External Groups with which the Candidate will interface:
Required Skills/Experience:
Preferred Skills/ Experience:
ICU, Medical Surgical background, bedside experience (Home health nurses)1.Medicare experience (Utilization Management with Medicare)
Utilization Review (Prior Authorization)2.CCM Certification
Acute Care3.ACLS Certification
Education Requirement:Bachelors 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