Wheeler Staffing Partners
Prior Authorization Nurse (LVN/RN)
Wheeler Staffing Partners, California, Missouri, United States, 65018
Job Title:
Prior Authorization Nurse (LVN/RN – California License)
Employment Type:
Contract
Location:
Fully Remote
Schedule:
Monday – Friday | 8:00 AM – 5:00 PM PST
Pay Rate:
$30 – $34 per hour
License Requirement:
Active LVN or RN License (California)
Job Summary:
Wheeler Staffing Partners is hiring a Prior Authorization Nurse for a fully remote contract position. This role supports medical management functions by reviewing, screening, coordinating, and processing referrals for medical services. The nurse will utilize review criteria, policies, and guidelines to ensure appropriate, cost‑effective, and high‑quality care is delivered to members in the correct setting.
Essential Duties and Responsibilities
Process referral determinations using Milliman Care Guidelines
Identify and refer complex cases to medical director
Ensure accurate coding and letter documentation (denials, deferrals, modifications)
Select appropriate, contracted providers
Verify member eligibility and health plan benefits
Route records and trigger appropriate determination notices
Maintain compliance with turnaround time standards (ICE TAT)
Meet or exceed quality and productivity standards
Collaborate with providers and medical directors
Identify and refer members to case management or disease management programs
Attend required training and team meetings
Maintain confidentiality of records and documentation
Communicate and collaborate across internal departments
Required Qualifications
Active LVN or RN license in the state of California
3–5 years of utilization review experience
2 years of managed care or medical management experience preferred
ICD‑9 and CPT coding knowledge preferred
Experience with EZ‑CAP system preferred
Proficiency in Microsoft Word, Excel, Outlook
Effective verbal and written communication skills
Ability to work independently in a remote setting
Education and Experience
Minimum Education: LVN License (California)
Preferred Education: Bachelor’s Degree in Nursing (BA or BSN)
3–5 years acute care experience
2 years health plan utilization review or equivalent
Preferred Experience:
5 years of utilization review in a health plan setting
5 years acute care experience
1 year ICU or Emergency Room experience
About Wheeler Staffing Partners:
Wheeler Staffing Partners is a professional staffing firm that connects skilled professionals with top employers across the country. We are committed to supporting healthcare providers and organizations with high‑quality staffing solutions.
To apply, submit your resume today. Qualified candidates will be contacted promptly.
#J-18808-Ljbffr
Prior Authorization Nurse (LVN/RN – California License)
Employment Type:
Contract
Location:
Fully Remote
Schedule:
Monday – Friday | 8:00 AM – 5:00 PM PST
Pay Rate:
$30 – $34 per hour
License Requirement:
Active LVN or RN License (California)
Job Summary:
Wheeler Staffing Partners is hiring a Prior Authorization Nurse for a fully remote contract position. This role supports medical management functions by reviewing, screening, coordinating, and processing referrals for medical services. The nurse will utilize review criteria, policies, and guidelines to ensure appropriate, cost‑effective, and high‑quality care is delivered to members in the correct setting.
Essential Duties and Responsibilities
Process referral determinations using Milliman Care Guidelines
Identify and refer complex cases to medical director
Ensure accurate coding and letter documentation (denials, deferrals, modifications)
Select appropriate, contracted providers
Verify member eligibility and health plan benefits
Route records and trigger appropriate determination notices
Maintain compliance with turnaround time standards (ICE TAT)
Meet or exceed quality and productivity standards
Collaborate with providers and medical directors
Identify and refer members to case management or disease management programs
Attend required training and team meetings
Maintain confidentiality of records and documentation
Communicate and collaborate across internal departments
Required Qualifications
Active LVN or RN license in the state of California
3–5 years of utilization review experience
2 years of managed care or medical management experience preferred
ICD‑9 and CPT coding knowledge preferred
Experience with EZ‑CAP system preferred
Proficiency in Microsoft Word, Excel, Outlook
Effective verbal and written communication skills
Ability to work independently in a remote setting
Education and Experience
Minimum Education: LVN License (California)
Preferred Education: Bachelor’s Degree in Nursing (BA or BSN)
3–5 years acute care experience
2 years health plan utilization review or equivalent
Preferred Experience:
5 years of utilization review in a health plan setting
5 years acute care experience
1 year ICU or Emergency Room experience
About Wheeler Staffing Partners:
Wheeler Staffing Partners is a professional staffing firm that connects skilled professionals with top employers across the country. We are committed to supporting healthcare providers and organizations with high‑quality staffing solutions.
To apply, submit your resume today. Qualified candidates will be contacted promptly.
#J-18808-Ljbffr