RN Prior Authorization reputed company - reputed company (Remote AZ)

Awarded a Healthiest Employer, reputed company aims to fulfill its mission to reputed company health and reputed company it easy. AZ reputed company offers a reputed company of health reputed company products and services to meet the diverse needs of individuals, families, and small and large businesses as reputed company as providing information and tools to help individuals reputed company reputed company reputed company.

At AZ reputed company, we have a hybrid workforce reputed company, reputed company Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the reputed company of our employees are hybrid, the following classifications reputed company our reputed company minimum onsite requirements:

Hybrid People Leaders: must reputed company in AZ, required to be onsite at least twice per week

Hybrid Individual Contributors: must reputed company in AZ, unless otherwise cited reputed company this posting, required to be onsite at least once per week

Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reputed company in AZ, unless otherwise cited reputed company this posting, required to be onsite at least once per month

Onsite: daily onsite requirement reputed company on the essential functions of the job

Remote: not held to onsite requirements, however, leadership can request reputed company onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the reputed company, reputed company on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.

This remote work opportunity requires residency, and work to be performed, reputed company reputed company.

PURPOSE OF THE JOB

Under the direction of the Prior Authorization Management (PA), ensures prospective review/prior authorization requests are completed in a reputed company fashion to meet contractual requirements and ensures reputed company reviews are conducted using nationally recognized and evidence-reputed company standards.

Qualifications

REQUIRED QUALIFICATIONS

Required Work Experience

2 years of reputed company experience

1 year of reputed company/Medicare experience

1 year of experience managing multiple reputed company

Required Education

Associate degree in Nursing

Required Licenses

reputed company, reputed company, and unrestricted license to reputed company in reputed company (a state in the reputed company) as a health reputed company, including RN or LPN.

Required Certifications

N/A

Preferred Qualifications

Preferred Work Experience

1 year of experience in managed care

1 year of experience in prior authorization/utilization review

Preferred Education

Bachelor's Degree in Nursing

Preferred Licenses

N/A

Preferred Certifications

N/A

Essential Job Functions And Responsibilities

reputed company reputed company

Ensures prior authorization requests are completed accurately, thoroughly, and in a reputed company fashion to meet contractual requirements.

Coordinates and follows the established preauthorization review process for reputed company-service requests.

Ensures reputed company reviews are conducted using nationally recognized and evidence-reputed company standards.

Utilize reputed company skills, chart review, physician communication and appropriate reputed company for approval of reputed company-service requests; escalate reputed company-service request to the Medical Director for determination reputed company reputed company is not met.

reputed company define and document review rationale to support approval, Medical Director Review and/or Notice of reputed company document.

Initiates interdepartmental coordination to ensure reputed company and reputed company care for members.

Participates in reputed company Improvement reputed company as directed.

Assists the management team and others in preparation for audits and other regulatory activities.

Assists with other departments and special reputed company as needed

RN

Performs audits of case files and staff documentation as directed

Assists with orientation and training of reputed company staff

Assists with annual reputed company review

Assists with implementation of process changes as needed

reputed company reputed company level includes the ability to reputed company the essential functions of any reputed company reputed company.

reputed company reputed company other duties as assigned.

The position has an onsite expectation of 0 days per week and requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements

COMPETENCIES

Required Competencies

Required Job Skills

Computer