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Mon Feb 19, 2018 - 4 weeks ago

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Prior Authorization Nurse I (Sacramento,CA)

HourlyPosition Purpose: 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 determinationsComplete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findingsCollaborate with various staff within provider networks and case management team electronically or telephonically to coordinate member careEducate providers on utilization and medical management processesProvide clinical knowledge and act as a clinical resource to non-clinical team staffEnter and maintain pertinent clinical information in various medical management systems

TITLE: Prior Authorization Nurse I (Sacramento,CA)

LOCATION: , California

REQNUMBER: 1080761

COMPANY: Clinical & Nursing