Prior Authorization Nurse
The purpose of the prior authorization nurse is to provide timely review of authorization requests and ensure the requests meet national standards and contractual requirements. The prior authorization nurses will also promote the quality and cost effectiveness of patient care using clinical acumen. Additionally, the nurses will prepare documentation, perform audits of patient records, and assist management as needed.
Daily Responsibilities:
- Perform clinical reviews of authorization requests using appropriate criteria
- Provide accurate and complete documentation with rationale used to approve request
- Collaborate with various staff within provider networks and case management team coordinate patient care
- Equip and train prior authorization tech with needed resources
- Ability to multitask between computer and multi-line phone requests
- Participate in interdepartmental projects when needed
- Enter and maintain clinical information in multiple health management systems
Skills and Qualifications:
- Bachelor’s or Associate Degree in Nursing (Bachelor’s preferred)
- State licensure as a Registered Nurse (RN)
- Minimum of two (2) years of experience in acute clinical nursing setting
- Knowledge of utilization management and case management principles preferred
- Prior authorization experience preferred
- Advanced verbal, written communication, and organization skills
- Knowledge of Microsoft word
- Drive to work well with a team
- Strong service orientation and professionalism