Prior Authorization Registered Nurse (Fully Remote Position) Posted Date: July 02, 2021

Job Description

An exciting and lucrative opportunity just became available for an experienced Registered Nurse to work for a highly regarded healthcare company. This is a full-time remote position. The Registered Nurse will be responsible for processing prior authorizations for a variety of health plans.


? Flexible Schedules
? Competitive Pay/Benefits
? Fast Growing Healthcare Organization
? Fully Remote Position
? Ample Growth Opportunity

Job Description:

? Responsible for reviewing and processing requests for authorization and notification of medical services from health professionals, commercial lines of business, clinical facilities and ancillary providers.
? Focused on reviewing complex and/or costly authorization requests (many cancer treatments, new meds, procedures and technologies)
? Responsible for tasks/functions related to prior authorization and referral. Actively participating in telephone on-line responsibilities as well as selected off-line tasks/functions.
? Responsible for applying medical criteria and policies/procedures to authorization or referral requests from medical professionals, clinical facilities and ancillary providers.
? Directly interact with provider callers, acting as a resource for their needs. UM experience needed.
? Reviews ICD-10, CPT-4 and HCPCS codes for accuracy and existence of coverage specific to the line of business.

Experience & Education:

? Current, unrestricted RN license
? 3+ years of Clinical Experience
? 1+ years of Utilization Management/ Prior Authorization Review experience required.
? Strong knowledge of Commercial Lines, Medicare and Medi-Cal guidelines

Schedule: Monday - Friday (8 am to 5pm)

Start Date: ASAP

Interview: Via Zoom Meeting ALL's WELL is proud to be an Equal Opportunity Employer. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment qualified applicants with arrest and conviction records.