Pre-Authorization Nurse - Kentucky Remote

Profile

Description

The Pre-Authorization Nurse 1 reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. The Pre-Authorization Nurse 1 work assignments are often straightforward and of moderate complexity. Will work Monday through Friday 9a - 6p.

Responsibilities

The Pre-Authorization Nurse 1 completes medical necessity reviews for requested services using clinical judgment, and refers to internal stakeholders for review depending on case findings.


Educates providers on utilization and medical management processes.
Enters and maintains pertinent clinical information in various medical management systems. Understands own work area professional concepts/standards, regulations, strategies and operating standards.
Makes decisions regarding own work approach/priorities, and follows direction.
Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation.
Hours: Typically an 8 hours shift Monday-Friday between 9:00 AM and 6:00 PM EST with rotating on-call coverage and oversight during weekends and holidays.
Primary Location: Work at home - With Kentucky License


Required Qualifications


Unrestricted Licensed Registered Nurse (RN) in the state of Kentucky or Compact License with no disciplinary action and ability to hold licenses in multiple states without restriction.
2 Progressive clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
Strong Proficiency with MS Office Suite to include Word, Excel, Power Point,
2 years Technical experience aptitude to troubleshoot and resolve system platform and connectivity problems
Ability to work independently under general instructions and with a team


Additional Requirements:


Hours: Typically an 8 hours shift Monday-Friday between 9:00 AM and 6:00 PM EST with rotating on-call coverage and oversight during weekends and holidays.
Primary Location: Work at home - with Kentucky License
Work Style: This position is a work at home role and will require the following:
Must ensure absolute and continuous privacy while you work within a home office or other remote location.
Must have accessibility to hardwired high speed internet with minimum speeds of 10Mx1M for a home office (Wireless and Satellite are prohibited)


Preferred Qualifications


Bachelor's Degree
1 year Utilization Management experience
MCG experience
Health Plan experience
Medicaid experience
Bilingual is a plus - Language Proficiency Assessment will be performed to test fluency in reading, writing and speaking in both languages before placing on a dedicate line to service our members.


Additional Information:

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

Company info

Sign Up Now - WashingtondcCrossing.com