Prior Authorization Nurse
10bits - Hamilton, Ohio, United States, 45011Work at 10bits
Overview
- Apply
Overview
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