Axelon Services Corporation
Clinical - Clinical Review Nurse - Prior Authorization - J00927
Axelon Services Corporation, Austin, Texas, us, 78716
Location :
Fully Remote, TX central time zone preferred, Must have compact state licensure an / or Texas licensure
SHIFT :
Training – - weeks : Mon - Fri AM – PM CST (No days off) CAMERA ON : Work schedule Mon - Fri AM-PM CST - hour lunch
Duration :
+ months
Job Description :
Job Profile Summary
Position Purpose :
Purpose : to perform prior authorization clinical reviews for Texas Marketplace members, additionally, will need to assist with non-par (out of network) redirections
Team currently consists of prior authorization nurses performing this work, it is a team effort, collaboration with team members is available to answer any questions and training will be handled at the team level.
Day to day will include performing clinical reviews for prior authorization requests utilizing policies, Interqual, sending to the MD if needed. Additionally, will assist with out of network requests and redirecting to in network providers as needed.
Performance expectations will include completing at least clinical reviews per day and if assisting with out of network requests will perform redirections per hour
This role is unique as it supports Marketplace expansion for Texas
Candidate Requirements Education / Certification Required : ADN, BSN - Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and – years of related experience Preferred : Licensure Required : RN Preferred : Years of experience required : - years
Disqualifiers :
LVN
Additional qualities to look for : True care experience
#J-18808-Ljbffr
Fully Remote, TX central time zone preferred, Must have compact state licensure an / or Texas licensure
SHIFT :
Training – - weeks : Mon - Fri AM – PM CST (No days off) CAMERA ON : Work schedule Mon - Fri AM-PM CST - hour lunch
Duration :
+ months
Job Description :
Job Profile Summary
Position Purpose :
Purpose : to perform prior authorization clinical reviews for Texas Marketplace members, additionally, will need to assist with non-par (out of network) redirections
Team currently consists of prior authorization nurses performing this work, it is a team effort, collaboration with team members is available to answer any questions and training will be handled at the team level.
Day to day will include performing clinical reviews for prior authorization requests utilizing policies, Interqual, sending to the MD if needed. Additionally, will assist with out of network requests and redirecting to in network providers as needed.
Performance expectations will include completing at least clinical reviews per day and if assisting with out of network requests will perform redirections per hour
This role is unique as it supports Marketplace expansion for Texas
Candidate Requirements Education / Certification Required : ADN, BSN - Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and – years of related experience Preferred : Licensure Required : RN Preferred : Years of experience required : - years
Disqualifiers :
LVN
Additional qualities to look for : True care experience
#J-18808-Ljbffr