Axelon Services Corporation
Clinical - Clinical Review Nurse - Prior Authorization - J00927
Axelon Services Corporation, Charlotte, North Carolina, United States, 28269
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Job Title:
Clinical - Clinical Review Nurse Work Mode:
Remote Duration:
3 months Schedule:
Work Mon-Fri 8a-8p PST with occasional weekend/holiday work with team rotating schedule
Job Description:
Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage. Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care. Will review up to 20 auth reviews per day.
Requirements:
Must possess an OR license and at least 2 years of Prior Authorization experience.
Typical Day in the Role:
Daily schedule & OT expectations Typical task breakdown and rhythm Interaction level with team Work environment description Has the ability to review both PA and IP requests Candidate Requirements: LPN/RN in Nursing; Must have at least 2 years prior experience in Prior Authorization with an Insurance company
Education/Certification:
Required: LPN/AS RN Preferred: RN Top 3 must-have hard skills: Previous experience with prior auth Must be a team player that works well independently Must be willing to work a flexible schedule of 1 weekend a month, a few holidays per year
Job Title:
Clinical - Clinical Review Nurse Work Mode:
Remote Duration:
3 months Schedule:
Work Mon-Fri 8a-8p PST with occasional weekend/holiday work with team rotating schedule
Job Description:
Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage. Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care. Will review up to 20 auth reviews per day.
Requirements:
Must possess an OR license and at least 2 years of Prior Authorization experience.
Typical Day in the Role:
Daily schedule & OT expectations Typical task breakdown and rhythm Interaction level with team Work environment description Has the ability to review both PA and IP requests Candidate Requirements: LPN/RN in Nursing; Must have at least 2 years prior experience in Prior Authorization with an Insurance company
Education/Certification:
Required: LPN/AS RN Preferred: RN Top 3 must-have hard skills: Previous experience with prior auth Must be a team player that works well independently Must be willing to work a flexible schedule of 1 weekend a month, a few holidays per year