Clinical - Clinical Review Nurse - Prior Authorization - J00927

Location : Fully Remote, All candidates MUST reside in CA

SHIFT : Training Mon - Fri 8-5PM PST 4-6 week course NO TIME OFF for first 90 days CAMERA MUST BE ON. Work Shift : Mon - Fri 8-5PM PST. NO OT, Holidays or weekends

Duration : 12 months, Possibility to convert to FTE if position opens

Requirements : CA RN License Required

Job Description : Required to review and process Prior Authorizations Which includes processing letters.

Position Purpose : Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage. Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care.

Must Haves : Years of experience required : 2-3 years of clinical experience. UM a plus,

Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred.

Knowledge of Medicare and Medicaid regulations preferred.

Knowledge of utilization management processes preferred.

Microsoft Office Suite product knowledge (Teams, one note, excel and word) / tech savvy

Disqualifiers : Not having a CA RN license, No long pauses in recent work history,

Candidate Requirements

Education / Certification

Required : Requires Graduate from an Accredited School of Nursing or Bachelor s degree in Nursing and 2 4 years of related experience.

Licensure

Required : RN CA licensure required

Pay Range : $40-44 / hr