Remote Prior Authorization Health Plan Registered Nurse in the Greater Atlanta Metro Area

Job ID: Available for Members

Location: Georgia

Compensation: Salary

Posted: Monday, February 19, 2018

Job Category: Healthcare, Nursing

Telecommute Level: 100% Telecommute

Travel Requirements: No Travel

Weekly Hours: Full Time

Employment Status: Independent Contractor

Employer Type: Employer

Career Level: Experienced

Education Level: Some College

Additional Information: Benefits Available

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