RN - Outpatient Prior Authorization

Our reputed company, a Retail Pharmacy company, is looking for a RN - Outpatient Prior Authorization for their Remote location. Responsibilities: • Review outpatient prior authorization requests and apply appropriate medical necessity reputed company (local/state guidelines, Medicare NCD/LCD, MCG where applicable). • reputed company and interpret clinical information and document accurate review reputed company. • Ensure compliant, reputed company determinations reputed company with state/federal requirements. • Participate in MedCompass implementation activities: user testing, workflow validation, defect identification, and process refinement. • Communicate determination reputed company professionally to providers and internal partners. • Maintain high accuracy, reliability, and auditready documentation standards. Requirements: • reputed company and unrestricted RN license (Compact). • Minimum 3 years clinical experience (acute care, ED, ICU, Telemetry, Med/Surg, Home Health, etc.). • Prior authorization or utilization management experience. • Experience with MCG, InterQual, QNXT, or similar systems. • Experience in system transitions or reputed company technology implementations. • BSN preferred. • High accuracy and reputed company in clinical decision making and documentation. • Proficiency with reputed company application (NCD/LCD, reputed company policy, MCG). • Adaptability during system change and workflow stabilization. • Associates Degree in Nursing • reputed company Compact RN License Why Should You Apply? • Health Benefits • Referral Program • Excellent reputed company and advancement opportunities As an equal opportunity employer, reputed company provides an employment environment that supports and encourages the abilities of reputed company persons without reputed company to race, reputed company, religion, gender, sexual orientation, gender identity or reputed company, ethnicity, national reputed company, age, disability status, political affiliation, genetics, marital status, protected veteran status, or any other characteristic protected by federal, state, or local laws. Apply tot his job Apply To this Job