Pre-Authorization Nurse

This is a fully remote position, open to applicants in United States.

📋 Description

• Assess prior authorization requests to ensure proper care and environment.

• Adhere to guidelines and policies when approving services or directing requests to the relevant stakeholder.

• Conduct medical necessity and level-of-care assessments using clinical expertise.

• Refer cases to colleagues for further review based on assessment outcomes.

• Provide education to providers regarding utilization and medical management protocols.

• Input and manage pertinent clinical data within medical management systems.

• Analyze department, segment, and organizational strategies along with operational objectives.

• Make autonomous decisions concerning work methods in uncertain circumstances.

• Comply with established guidelines and procedures.

⛳️ Requirements

• Minimum of 2 years of RN experience.

• Valid RN license in the state of Indiana.

• Capability to obtain licensure in multiple states without restrictions.

• Prior experience in utilization management, case management, discharge planning, and/or home health or rehabilitation.

• Proficient in MS Office applications, including Word, Excel, and Outlook.

• Ability to work independently under general supervision as well as collaboratively within a team.

• Minimum home internet download speed of 25 Mbps.

• Minimum home internet upload speed of 10 Mbps.

• Designated workspace free from ongoing interruptions to safeguard member PHI / HIPAA information.

🏝️ Benefits

• Bonus incentive program based on company and/or individual performance.

• Medical insurance.

• Dental insurance.

• Vision insurance.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability coverage.

• Long-term disability coverage.

• Life insurance.

• Additional wellness and healthcare benefits.

• Remote work option.

• Company-sponsored training or travel to meetings may be required.