Licensed Authorization Nurse

Job Summary

To support healthcare operations, the full-time Licensed Authorization Nurse will obtain referrals and authorizations for acute admissions and treatments, leveraging clinical expertise while working remotely during daylight hours with occasional weekend and holiday shifts.

Key responsibilities

• Serve as a liaison between care managers and payors, facilitating necessary communications
• Collaborate with departments to ensure all documentation is obtained for authorization and medical appropriateness
• Perform clinical reviews and maintain knowledge of regulatory guidelines related to authorizations

Required qualifications

• RN required; BSN or Bachelor's degree preferred
• 5 years of acute care clinical experience
• 2 years of payer or care management experience
• Understanding of medical necessity criteria (InterQual) and prior utilization review experience
• Registered Nurse (RN) licensure in the practicing state