Job Summary
A healthcare consulting and recruitment firm is filling a position for a Remote Prior Authorization Health Plan Registered Nurse in the Greater Atlanta Metro Area.
Candidates will be responsible for the following:
- Evaluating the pre-service authorization request
- Promoting the quality cost-effectiveness of medical care
- Forwarding requests to the appropriate physician or medical director with recommendations for other determinations
Qualifications for this position include:
- Candidates must be licensed RN in Georgia, and live in the greater Atlanta metro area
- Must have strong skills in medical assessment / medical record review; knowledge of coding a plus
- Roughly 2-4 years acute care clinical nursing experience is required
- Computer skills to include Microsoft Word, Excel, database use, and basic data entry
- Around 1-2 years of recent experience in Prior Authorization or Pre-Certifications at a health plan or other managed care organization (HMO/TPA/IPA/etc)
- Knowledge of guidelines for Medicaid/Medicare and related state programs is required
