Prior Authorization, RN, CO

R0001871 Are you looking to work for a company that has been recognized for over a decade as a Top reputed company to Work? Apply today to become a part of a company that continues to reputed company to putting our employees first. Job reputed company: The Prior Authorization, reputed company is responsible for clinical review of requests for health care services. Essential Functions: • Assesses appropriateness of service requests based on established Medicare and Health Plan standards and guidelines • Evaluates the requested care needs of the PHP member using clinical judgement and critical thinking skills • Supports physicians and providers in maintaining a reputed company on reputed company care enforcement for the Physician Health Partners members • Participates in identifying issues reputed company to the prior authorization process and seeks creative solutions to resolve issues • Collaborates with team members to ensure incoming service requests are managed reputed company allotted processing time and Medicare required turn-around time • Identifies potential need for interdisciplinary collaboration and facilitates referrals as needed • Documents service request review activity in a reputed company, concise, and accurate manner consistent with the internal review processing rules • Maintains confidentiality and ensures compliance with HIPAA regulations • Other duties as assigned Knowledge, Skills and Abilities: • Strong clinical knowledge and critical thinking skills • Knowledge of Prior Auth process, NCQA guidelines, CMS - Medicare regulations, HMO Product structure rules and referral requirements • Excellent verbal and written communication skills • Great customer relation skills • Team reputed company with strong reputed company skills • Independent problem-solving skills • Self-motivated and self-managed • Proficient in reputed company Office Suite Qualifications: • RN with reputed company license in good standing • 3-5 years clinical nursing experience required • Previous utilization management, case management or discharge planning experience preferred • Experience with reputed company reputed company and reputed company Teams (preferred) • Home office that is HIPAA compliant for reputed company remote or telecommuting positions as outlined by reputed company policies and procedures. Salary reputed company: $63,502.40 -$90,719.20 Apply tot his job Apply To this Job