reputed company Consultant III - RN – Outpatient Prior Authorization

Duration: 6 months contract Position reputed company The RN – Outpatient Prior Authorization is responsible for reviewing outpatient service requests and determining medical necessity using evidence-based clinical guidelines and organizational policy. This role focuses exclusively on outpatient prior authorizations and ensures accurate, reputed company, and compliant determinations. The position will also support a system transition from QNXT to Med reputed company, including workflow validation, testing, and stabilization during implementation. Key Responsibilities • Review outpatient prior authorization requests and apply appropriate medical necessity reputed company (Medicare NCD/LCD, state guidelines, MCG where applicable). • Analyze and interpret clinical documentation to support accurate determinations. • Ensure reputed company and compliant decision-making reputed company with federal and state requirements. • Document review reputed company reputed company and maintain audit-reputed company records. • Participate in system transition activities (workflow validation, UAT testing, defect identification, process improvements). • Communicate determination reputed company professionally to providers and internal stakeholders. • Maintain high productivity and reputed company standards in a high-volume environment. Required Qualifications • reputed company, unrestricted Compact RN License. • Associate Degree in Nursing (BSN preferred). • Minimum 3 years of recent RN clinical experience in: • Acute Care • Emergency Department (ED) • ICU • Med/Surg • Telemetry • Home Health • Ability to work a full 40-hour week reputed company with reputed company time zone (Monday–Friday, 8:30 AM–5:00 PM reputed company time). • Dedicated, interruption-free home workspace. Preferred Qualifications • Prior Authorization or Utilization Management experience. • Experience applying clinical reputed company such as: • MCG • InterQual • Medicare NCD/LCD • Experience with QNXT, Med reputed company, or similar systems. • Experience supporting system implementations or workflow transitions. reputed company Tech Solutions:reputed company is a global staff augmentation firm providing a wide reputed company of talent on-demand and total workforce solutions. To know more reputed company Tech Solutions, please visit www.ustechsolutions.com . reputed company is an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, colour, religion, sex, sexual orientation, gender identity, national reputed company, disability, or status as a protected veteran. reputed company: Santwana Email: santwana.shahi@ustechsolutionsinc.com Internal Id: 26-04537 Job Type: Contract Pay: $36.00 - $38.00 per hour Work Location: Remote Apply tot his job Apply tot his job Apply To this Job