REMOTE Prior Authorization Nurse
Actalent
Remote
remote
prior authorization
nurse
medical
prior authorization
management
team
medical management
nursing
remote
nurses
cost
director
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September 18, 2022
Actalent
Chattanooga, Tennessee
FULL_TIME
$31-35/YEAR
Actalent is currently partnering with a payor system in the Atlanta area hiring multiple remote Prior Authorization Nurses. Please see below for details and qualifications! Description: + Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests.
+ Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determination. + Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings. + Collaborate with various staff within provider networks and case management team electronically or telephonically to coordinate member care.
+ Educate providers on utilization and medical management processes. + Provide clinical knowledge and act as a clinical resource to non-clinical team staff Enter and maintain pertinent clinical information in various medical management systems. Skills & Qualifications: + Graduate from an Accredited School of Nursing + Active RN or LPN license required + Bachelors degree in Nursing preferred + Knowledge of healthcare and managed care preferred + 1+ years of experience required Details: + Entry Level + 1st shift M-F EST + $31-35/hr, based on experience About Actalent: Actalent connects passion with purpose.
Our scalable talent solutions and services capabilities drive value and results and provide the expertise to help our customers achieve more. Every day, our experts around the globe are making an impact. We're supporting critical initiatives in engineering and sciences that advance how companies serve the world.
Actalent promotes consultant care and engagement through experiences that enable continuous development. Our people are the difference. Actalent is an operating company of Allegis Group, the global leader in talent solutions.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law..
+ Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determination. + Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings. + Collaborate with various staff within provider networks and case management team electronically or telephonically to coordinate member care.
+ Educate providers on utilization and medical management processes. + Provide clinical knowledge and act as a clinical resource to non-clinical team staff Enter and maintain pertinent clinical information in various medical management systems. Skills & Qualifications: + Graduate from an Accredited School of Nursing + Active RN or LPN license required + Bachelors degree in Nursing preferred + Knowledge of healthcare and managed care preferred + 1+ years of experience required Details: + Entry Level + 1st shift M-F EST + $31-35/hr, based on experience About Actalent: Actalent connects passion with purpose.
Our scalable talent solutions and services capabilities drive value and results and provide the expertise to help our customers achieve more. Every day, our experts around the globe are making an impact. We're supporting critical initiatives in engineering and sciences that advance how companies serve the world.
Actalent promotes consultant care and engagement through experiences that enable continuous development. Our people are the difference. Actalent is an operating company of Allegis Group, the global leader in talent solutions.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law..
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