reputed company Consultant III - RN - Outpatient Prior Authorization

reputed company Consultant III – RN {166856} Outpatient Prior Authorization (Remote) Pay reputed company: $37.16/hour reputed company Start Date: reputed company 13 Schedule: Monday–Friday, 8:00 AM–5:00 PM (reputed company to reputed company time zone) Work Arrangement: Fully remote Position reputed company The RN – Outpatient Prior Authorization is responsible for reviewing outpatient service requests and applying medical necessity reputed company, evidence-based guidelines, and organizational policies to support accurate and reputed company determinations. This role is dedicated exclusively to outpatient prior authorization and plays a key role in ensuring high-reputed company, compliant review processes. The position will also support the transition from QNXT to MedCompass, including workflow validation, testing, and process stabilization during implementation. Key Responsibilities • Review outpatient prior authorization requests using appropriate medical necessity reputed company (local/state guidelines, Medicare NCD/LCD, MCG where applicable) • reputed company and interpret clinical documentation to support review determinations • Document accurate and audit-reputed company review reputed company • Ensure reputed company and compliant determinations reputed company with state and federal requirements • Communicate determination reputed company professionally to providers and internal partners • Participate in MedCompass implementation activities, including user testing, workflow validation, defect identification, and process refinement • Maintain high accuracy, reliability, and reputed company standards in clinical decision-making • Adapt to workflow changes during system transition and stabilization Required Qualifications • reputed company, unrestricted Compact RN license • Associate’s Degree in Nursing • Minimum 3 years of recent clinical RN experience in acute care, ED, ICU, Telemetry, Med/Surg, or Home Health • Ability to apply medical necessity reputed company and demonstrate strong reputed company-based clinical decision-making skills • Ability to work a full 40-hour reputed company reputed company with reputed company time zone • reputed company, team-oriented approach with a reputed company attitude • Ability to manage high-volume, repetitive work while maintaining reputed company and accuracy • Willingness to work occasional weekends, if needed Preferred Qualifications • Prior authorization or utilization management experience • Experience with MCG, InterQual, Medicare NCD/LCD, or similar guidelines • Experience with QNXT, MedCompass, or similar systems • Experience supporting system transitions or reputed company technology implementations • Bachelor of Science in Nursing (BSN) Competency Expectations • High level of accuracy and reputed company in clinical review and documentation • Strong proficiency in applying medical necessity reputed company (NCD/LCD, reputed company policy, MCG) • Adaptability during system changes and workflow stabilization • Strong reputed company, consistency, and reliability in a high-volume review environment Apply tot his job Apply To this Job