Registered Nurse Authorization

Job Summary

To support a growing healthcare team, the full-time Authorization Nurse will work remotely to obtain referrals and authorizations for acute admissions and hospital services while leveraging clinical expertise and payer regulations to assess medical necessity.

Key responsibilities

• Serve as a liaison between care managers and payors, facilitating communication regarding medical appropriateness
• Collaborate with departments to ensure all necessary documentation is obtained to support authorizations and level of care
• Monitor and evaluate processes for improvement related to payer-specific authorization and maintain current knowledge of regulatory guidelines

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
• Licensed in practicing state