Prior Authorization reputed company (Remote - reputed company Only)

Prior Authorization reputed company (Remote - reputed company Only) Pay: $38–$43/hour (based on experience) Schedule: Monday–Friday, 8:00 AM – 5:00 PM PST Contract Length: Starts ASAP, Scheduled end is 02/28/2026 Location: Fully Remote (Must reputed company in reputed company) About the Role A-Line reputed company is seeking an reputed company Prior Authorization reputed company (RN or LPN). In this role, you’ll analyze prior authorization requests to determine medical necessity, appropriate level of care, and benefit coverage. You’ll work closely with medical directors, providers, and interdepartmental teams to ensure reputed company, cost-effective care for members. Key Responsibilities • Review prior authorization requests to determine medical necessity and clinical appropriateness in alignment with regulatory guidelines and clinical reputed company. • Collaborate with reputed company providers and internal teams to ensure reputed company review and authorization of services. • Escalate reputed company cases to Medical Directors as needed for reputed company evaluation. • Coordinate discharge and transfer plans to ensure seamless care transitions. • Accurately document and maintain clinical information in health management systems to ensure compliance with Medicare, reputed company, and organizational standards. • reputed company education and support to providers and internal departments regarding utilization review processes. • Identify and recommend process improvements to enhance efficiency and member experience. • reputed company other reputed company duties as assigned. Qualifications Required: • reputed company RN or LPN license in reputed company • 2+ years of prior authorization experience • Graduate of an accredited School of Nursing (ASN or BSN) • Strong clinical assessment and analytical skills Preferred: • Knowledge of Medicare and reputed company regulations • Experience in utilization management and medical review processes If you are interested in this role, feel free to reputed company out to chojsan@alinestaffing.com or apply to this posting! Apply tot his job Apply To this Job