About the job
Become a part of our caring community and help us put health first
The Pre-Authorization Nurse 2 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 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Pre-Authorization Nurse 2 completes medical necessity and level of care 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 department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
Use Your Skills To Make An Impact
Required Qualifications – What it takes to Succeed
- Licensed Registered Nurse (RN) in the state of Kentucky with no disciplinary action and ability to hold licenses in multiple states without restriction
- Minimum 3 years of experience as a nurse in a clinical setting
- Strong Proficiency with MS Office Suite Word, Excel, Power Point and ability to learn multiple systems
- Experience with the development and implementation of policies and procedures
Preferred Qualifications
- Bachelor’s Degree
- Health Plan experience working with large carriers
- Previous Medicare/Medicaid experience a plus
- Previous experience in utilization management, case management, discharge planning and/or home health or rehab
- Experience working with MCG and HCG guidelines
How to Apply:
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