Prior Auth Nurse
Posted 1 week ago by 1750419597
Negotiable
Outside
Remote
USA
Summary: Immediate opportunity for a Prior Auth Nurse in a remote capacity for a contract lasting over six months, with potential for long-term engagement. The role involves analyzing prior authorization requests and providing recommendations to medical teams to ensure quality care. Candidates should possess relevant nursing qualifications and experience in prior authorization processes. Interested applicants are encouraged to apply promptly.
Key Responsibilities:
- 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.
Key Skills:
- Care manager
- Prior authorization
- Medical knowledge
- Computer skills
- Care manager or clinical nursing experience
- Prior Authorization Nurse, Medical Review Nurse, Appeals Nurse, Utilization Management or Quality Assurance Nurse experience
- Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing and 2-4 years of related experience
- Nursing Licensure
Salary (Rate): £36 hourly
City: undetermined
Country: USA
Working Arrangements: remote
IR35 Status: outside IR35
Seniority Level: undetermined
Industry: Healthcare
Immediate need for a talented Prior Auth Nurse . This is a 06+months contract opportunity with long-term potential and is located in Ohio (Remote). Please review the job description below and contact me ASAP if you are interested.
Job ID: 25-75553
Pay Range: $36 - $40/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
Key Responsibilities:
- 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.
Key Requirements and Technology Experience:
- Key Skills; Care manager
Prior authorization
Medical knowledge - Computer skills, medical knowledge,
- Care manager or clinical nursing experience
- Works well for this role: Prior Authorization Nurse, Medical Review Nurse, Appeals Nurse, Utilization Management or Quality Assurance Nurse
- Requires Graduate from an Accredited School of Nursing or Bachelor s degree in Nursing and 2 4 years of related experience.
- Required: Nursing Licensure
Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy .