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Pre-Authorization Nurse Florida

Company: VirtualVocations
Location: Fullerton
Posted on: November 16, 2024

Job Description:

A company is looking for a Pre-Authorization Nurse to review prior authorization requests for appropriate care and settings.



Key Responsibilities

Conduct medical necessity and level of care reviews using clinical judgment
Refer cases to internal stakeholders and educate providers on utilization and medical management processes
Maintain clinical information in medical management systems and communicate with providers or members


Required Qualifications

Licensed Registered Nurse (RN) in Florida or a compact state with no disciplinary action
2 or more years of Utilization Management (UM), Pre-Auth, or managed care review experience
1 or more years of acute and/or critical care clinical experience
Proficient with MS Office Word, Excel, and Outlook
Availability to work Tuesday - Saturday, 8am-5pm EST, with potential overtime and holidays

Keywords: VirtualVocations, Buena Park , Pre-Authorization Nurse Florida, Healthcare , Fullerton, California

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