Clinical - Clinical Review Nurse - Prior Authorization

Title: Clinical Review Nurse - Prior Authorization

Location: Remote

Duration: 6 Months (possibility of extension and conversion)

Schedule: 8am 5pm CST Mon Fri Possible holiday shifts

PR: XXXXXXXXXXX to XXXXXXXXXXX/hr.

Responsibilities

• Consolidate clinical information into an easy-to-read summary.
• Conduct medical necessity reviews with clinical information, using clinical policies and criteria.
• Collaboration with Medical Directors
• Maintain adequate time management as the workload is high and can change throughout the day.
• Work with transplant providers at the facilities to gather clinical information.
• Ensure appropriate case management and contracting is in place for each transplant authorization.
• The expectation is that this RN can handle a caseload equivalent to a FTE nurse once fully trained.
• This role is unique in that our team only reviews for transplant authorizations, so this is a specialized role.

Education And License Required

• RN degree
• Current state RN license only (no LPNs)
• Compact Nursing License Preferred

Years of experience required

• 3+ years of Utilization Management/ Prior Authorization experience.

Additional qualities to look for

• Transplant Medical Necessity Review experience in a Utilization Management environment or Transplant Surgical experience.