Prior Authorization Nurse (6999123)
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PA Nurses for denials: mainly for inpatient concurrent review. Previous workers in the positions worked in concurrent review or prior authorization.
LVN or RN is OK.
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
* Interact with providers to educate and direct care to participating network providers
* Participate in utilization management committees and work on special projects related to utilization management as needed
We know that a company's success starts with its employees. We also know that an individual's success starts with the right career opportunity. As a Best of Staffing Client and Talent leader, Aerotek's people-focused approach yields competitive advantage for our clients and rewarding careers for our contract employees. Since 1983, Aerotek has grown to become a leader in recruiting and staffing services. With more than 250 non-franchised offices, Aerotek's 8,000 internal employees serve more than 300,000 contract employees and 18,000 clients every year. Aerotek is an Allegis Group company, the global leader in talent solutions. Learn more at Aerotek.com.