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Registered Nurse Job in Detroit, Michigan : MI

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Prior Authorization Registered Nurse

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A-Line Staffing Solutions
Health Care, Nurse, Other
Detroit
Michigan
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Prior Authorization Registered Nurse Job Description




Prior Authorization Nurse / Concurrent Review Nurse 



Looking for full-time nurses of all backgrounds to staff a brand new department with a major insurance company.

Job Description:

  • Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests.
  • Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations
  • Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings
  • Collaborate with various staff within provider networks and case management team electronically or telephonically to coordinate member care
  • Educate providers on utilization and medical management processes
  • Provide clinical knowledge and act as a clinical resource to non-clinical team staff
  • Enter and maintain pertinent clinical information in various medical management systems


Qualifications:

  • Associate’s degree in Nursing or Nursing diploma from an Accredited School of Nursing or Bachelor’s degree in nursing preferred.
  • 2+ years of clinical nursing experience in an acute care setting.
  • Knowledge of healthcare and managed care preferred.
  • Licenses/Certifications: Current state’s RN license.


Please contact:

Katherine Skelton

877-782-3334, EXT 246

[Click Here to Email Your Resumé]


Detroit Registered Nurse Job

Prior Authorization Registered Nurse Job Requirements

Medical necessity, concurrent review, prior authorization, registered nurse, critical care, acute care, hospital nurse, insurance company nurse, health plan, managed care, Medicare, Medicaid, Charge nurse, auditing, chart audit, medical record review, coding, auditing
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