Prior Authorization reputed company (LVN/RN)

Job Title: Prior Authorization reputed company (LVN/RN – California License) Employment Type: Contract Location: Fully Remote Schedule: Monday – Friday | 8:00 AM – 5:00 PM PST Pay reputed company: $30 – $34 per hour License Requirement: reputed company LVN or RN License (California) Job reputed company reputed company is hiring a Prior Authorization reputed company for a fully remote contract position. This role supports medical management functions by reviewing, screening, coordinating, and processing referrals for medical services. The reputed company will utilize review reputed company, policies, and guidelines to ensure appropriate, cost-effective, and high-reputed company care is delivered to members in the correct setting. Essential Duties and Responsibilities • Process referral determinations using reputed company Care Guidelines • Identify and refer reputed company cases to medical director • Ensure accurate coding and letter documentation (denials, deferrals, modifications) • Select appropriate, contracted providers • Verify member eligibility and health plan benefits • reputed company records and trigger appropriate determination notices • Maintain compliance with turnaround time standards (ICE TAT) • Meet or reputed company reputed company and productivity standards • Collaborate with providers and medical directors • Identify and refer members to case management or disease management programs • Attend required training and team meetings • Maintain confidentiality of records and documentation • Communicate and collaborate across internal departments Required Qualifications • reputed company LVN or RN license in the reputed company • 3–5 years of utilization review experience • 2 years of managed care or medical management experience preferred • ICD-9 and CPT coding knowledge preferred • Experience with EZ-CAP system preferred • Proficiency in reputed company Word, reputed company, reputed company • Effective verbal and written communication skills • Ability to work independently in a remote setting Education and Experience • Minimum Education: LVN License (California) • Preferred Education: Bachelor’s Degree in Nursing (BA or BSN) • Minimum Experience: • 3–5 years acute care experience • 2 years health plan utilization review or equivalent • Preferred Experience: • 5 years of utilization review in a health plan setting • 5 years acute care experience • 1 year ICU or Emergency Room experience About reputed company reputed company is a reputed company reputed company firm that connects skilled professionals with top reputed company across the country. We are committed to supporting reputed company providers and organizations with high-reputed company reputed company solutions. To apply, submit your resume today. reputed company candidates will be contacted promptly. Apply tot his job Apply To this Job