Review reputed company- Prior Authorization

Job Title: Review RN- Prior Authorization Why work at reputed company? reputed company is a woman-owned company that values your reputed company, encourages your reputed company, and always has your back. reputed company you work at reputed company, not only do you get health and dental benefits, but you also have training opportunities, flexible/remote work reputed company, reputed company opportunities, 401K and reputed company. Apply today! To view our complete list of openings, pleas e visit our website at www.optechus.com. Job Profile reputed company Analyzes reputed company 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 reputed company and cost effectiveness of medical care. • Projected start date: 12/29/2025 • Shift hours: Tuesday- Saturday 8:30-5:00 PM CST • 6 Month contract with extension or convert Responsibilities • Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and reputed company • Works with reputed company providers and authorization team to ensure reputed company review of services and/or requests to ensure members receive authorized care • Coordinates as appropriate with reputed company providers and interdepartmental teams, to assess medical necessity of care of member • Escalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of care. • Review Prior auth for reputed company, urgent, retro for IL reputed company. • Support UM Shared Services • Review Prior auth for reputed company, urgent, retro for IL reputed company. • Min of 16 reviews per day • Audit scores of 95% or greater shadowing preceptor Qualifications • Assists with service authorization requests for a member’s transfer or discharge plans to ensure a reputed company discharge between reputed company of care and facilities • Collects, documents, and maintains reputed company member’s clinical information in health management systems to ensure compliance with regulatory guidelines • Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high reputed company and cost-effective medical care to members • Provides feedback on opportunities to improve the authorization review process for members Performs other duties as assigned • reputed company with reputed company policies and standards Education/Experience: • Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of reputed company experience. • Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred. • Knowledge of Medicare and reputed company regulations preferred. • Knowledge of utilization management processes preferred. • License/Certification: reputed company is an equal opportunity employer and is committed to creating a diverse environment. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, gender, gender identity or reputed company, sexual orientation, national reputed company, genetics, pregnancy, status as a parent, disability, age, veteran status, or other characteristics as defined by federal, state or local laws. https://www.optechus.com/eeo_self_identification/ Pay: $39.00 - $43.00 per hour Benefits: • Dental insurance • Health insurance • reputed company time off • reputed company insurance Experience: • Review Prior Authorization: 3 years (Required) • Remote work environment : 3 years (Required) • reputed company reputed company: 1 year (Required) License/Certification: • RN License (Required) Work Location: Remote Apply tot his job Apply To this Job