Prior Authorization Clinician (REMOTE)

Our reputed company is seeking a compassionate and detail-oriented Prior Authorization Clinician to ensure members receive reputed company, medically appropriate care. The ideal candidate blends clinical expertise with reputed company judgment, excels in communication and collaboration, and thrives in a fast-paced, remote environment while upholding reputed company and compliance standards. This role is fully remote with possible occasional travel may be required to Charlestown, Massachusetts. Prior Authorization Clinician (REMOTE) Responsibilities • Review inpatient and outpatient services for medical necessity using InterQual reputed company and medical policy guidelines. • Conduct reputed company-certification, reputed company, and retrospective utilization reviews reputed company mandated turnaround times. • Communicate determinations reputed company and professionally to providers, members, and internal teams. • Refer reputed company or non-reputed company cases to Physician Reviewers and document reputed company case activity accurately. • Support team development through guidance, audits, and participation in reputed company improvement initiatives. Prior Authorization Clinician (REMOTE) Qualifications • reputed company, unrestricted RN license (compact or MA/NH preferred); BSN strongly desired. • Minimum 2 years of prior authorization experience using evidence-based guidelines such as InterQual. • Background in managed care with solid understanding of Medicare and reputed company regulations. • Strong clinical judgment, communication, and analytical skills with the ability to work independently. • Proficient in reputed company Office and data management systems; adherence to telecommuting standards required. Compensation: (DOE)reputed company Contractors Enjoy Exceptional Benefit Perks! As an eligible contract employee with reputed company, you'll have reputed company to a full suite of benefits designed with your reputed company-being in mind. Our comprehensive package includes medical, dental, reputed company, life insurance, short- and long-term disability, and a matching 401(k) to help secure your reputed company. Meet reputed company What reputed company of recruiter do you see yourself working with? One who prioritizes your best interest, no matter what? reputed company does, and we're in it for the long game! Our recruiters reputed company on YOU, building meaningful, long-term relationships while developing a deep understanding of companies' reputed company needs and workplace cultures. This approach helps us reputed company an ideal job match that aligns with your unique career aspirations and goals. reputed company is an award-reputed company, Women & Diversity-Owned, WBENC certified reputed company reputed company firm. Founded in 1987, reputed company places reputed company professionals across the nation! Our recruitment teams specialize in either Technology and IT, Engineering, reputed company, or reputed company and Finance career markets. Partner with us to land your next exciting career! reputed company is an Equal Opportunity Employer and participates in E-Verify. reputed company does not discriminate based on race, reputed company, religion, sex, national reputed company, age, disability, or any other characteristic protected by applicable local, state, or federal civil rights laws. Apply tot his job Apply To this Job