Clinical Review Nurse- Prior Authorization Job at Pacer Group, Ohio

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  • Pacer Group
  • Ohio

Job Description

Title - Clinical Review Nurse- Prior Authorization

Duration - 6 months | Possibility to extend

Shift - 8 am- 5 pm

Location - Remote OH

Pay rate: XX35.00-42.00XX

Responsibilities

  • Clinical review and documentation of medical request for prior authorization of medically necessary services, sitting in front of a computer for 8 hours with allowance for breaks and 1 hour lunch, biweekly team huddles (virtual), and attention to emailed team instructions, proficient in toggling between multiple systems

  • BHP Prior Authorization Clinical Review Nurse
  • Biweekly team huddles (virtual), and attention to emailed team instructions, proficient in toggling between multiple systems
  • Review of prior auth requests for Medicaid Line of Business.
  • To assist the PA Team reviewing a backlog of requests from providers

Must haves:

  • Computer skills, medical knowledge,

  • Care manager or clinical nursing experience

  • Word, Excel, Virtual meeting skills MS outlook and EMR systems

Nice to haves:

  • Works well for this role: Prior Authorization Nurse, Medical Review Nurse, Appeals Nurse, Utilization Management or Quality Assurance Nurse

  • Critical thinking skills

  • good people skills and able to communicate needs

  • Comfortable with provider interaction

Disqualifiers : not having the requirements mentioned, remaining disqualifiers TBD during interview

Performance indicators : (Meet expectations) Quality documentation, timely processing of up to 18 authorizations per day on average, team player with positive attitude

Top 3

RN/LPN licensed professional

Comfortable toggling between multiple computer systems

Very agile and comfortable in fast paced environment

Prior Authorization experience

Education

  • Graduate from an Accredited School of Nursing or Bachelor s degree in Nursing and 2 4 years of related experience.

Licensure :

  • Nursing Licensure

Job Tags

Remote job, Shift work,

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