RN Prior Authorization Nurse

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Daily Responsibilities Prior Auth RN:

• Position Purpose: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests.

• Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations
• Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings
• Collaborate with various staff within provider networks and case management team electronically or telephonically to coordinate member care
• Educate providers on utilization and medical management processes
• Provide clinical knowledge and act as a clinical resource to non-clinical team staff
• Enter and maintain pertinent clinical information in various medical management systems

Requirements RN Prior Authorizations:

• RN license
• Associate’s degree in Nursing.
• Minimum of 2-5 years of clinical experience in acute setting
• One of these 2: experience authorizing services or experience calling in for auths from a provider setting
• Knowledge of utilization management principles and managed care.
• Must be comfortable with computers and with learning software programs

Hours for this Position:

M-F 8-5:30

Advantages of this Opportunity:

• Competitive salary ($64-78K) plus annual bonus
• Fun and positive work environment
• Room for growth
• Medical benefits 1st of the month after hire
• 401k Matching

Interested in being considered?

If you are interested in being considered for the position, please contact Ashley Greene at 407-478-0332 ext 169.