NJ Licensed Prior Authorization RN

Job Summary

A company is looking for a Prior Authorization Registered Nurse (RN).

Key Responsibilities

• Evaluate clinical needs against guidelines to determine medical necessity for services and procedures
• Develop and implement patient care plans to facilitate care transitions and service delivery
• Monitor care to ensure adherence to clinical guidelines and participate in quality improvement initiatives

Qualifications

• Active NJ or Compact RN license
• Reside in NJ, PA, NY, DE, or CT
• Minimum of 3 years of clinical RN experience
• At least 2 years of experience in a Health Plan within Prior Authorization or Utilization Review
• Proficiency in Microsoft Office Suite and understanding of hospital structures and payment systems