Clinical Review Nurse - Prior Authorization - J00927
Location: Fully Remote, TX, central time zone preferred
Must have compact state licensure and/or Texas licensure
SHIFT: Training 4-5 weeks (No Time Off); Mon - Fri 8AM 5PM CST (No days off) CAMERA ON
Shift schedule after training: 10 AM-7PM CST - 1 hour lunch, weekends
Duration: 3 months, Potential to extend and/or convert if position opens
Description: Job Profile Summary
ā¢ Purpose: to perform prior authorization clinical reviews for Texas Marketplace members, additionally, will need to assist with non-par (out of network) redirections
ā¢ Team currently consists of 21 prior authorization nurses performing this work, it is a team effort, collaboration with team members is available to answer any questions and training will be handled at the team level.
ā¢ Day to day will include performing clinical reviews for prior authorization requests utilizing policies, Interqual, sending to the MD if needed. Additionally, will assist with out of network requests and redirecting to in network providers as needed.
ā¢ Performance expectations will include completing at least 20 clinical reviews per day and if assisting with out of network requests will perform 2 redirections per hour
ā¢ This role is unique as it supports Marketplace expansion for Texas
Candidate Requirements
Required: Required: ADN, BSN - Requires Graduate from an Accredited School of Nursing or Bachelor s degree in Nursing and 2 4 years of related experience
Required:
Years of experience required: 2-4 years
Disqualifiers: LVN
Additional qualities to look for: True care experience
Remote
About the Company:
Axelon Services Corporation
Apply tot his job
Apply To this Job
Must have compact state licensure and/or Texas licensure
SHIFT: Training 4-5 weeks (No Time Off); Mon - Fri 8AM 5PM CST (No days off) CAMERA ON
Shift schedule after training: 10 AM-7PM CST - 1 hour lunch, weekends
Duration: 3 months, Potential to extend and/or convert if position opens
Description: Job Profile Summary
ā¢ Purpose: to perform prior authorization clinical reviews for Texas Marketplace members, additionally, will need to assist with non-par (out of network) redirections
ā¢ Team currently consists of 21 prior authorization nurses performing this work, it is a team effort, collaboration with team members is available to answer any questions and training will be handled at the team level.
ā¢ Day to day will include performing clinical reviews for prior authorization requests utilizing policies, Interqual, sending to the MD if needed. Additionally, will assist with out of network requests and redirecting to in network providers as needed.
ā¢ Performance expectations will include completing at least 20 clinical reviews per day and if assisting with out of network requests will perform 2 redirections per hour
ā¢ This role is unique as it supports Marketplace expansion for Texas
Candidate Requirements
Required: Required: ADN, BSN - Requires Graduate from an Accredited School of Nursing or Bachelor s degree in Nursing and 2 4 years of related experience
Required:
Years of experience required: 2-4 years
Disqualifiers: LVN
Additional qualities to look for: True care experience
Remote
About the Company:
Axelon Services Corporation
Apply tot his job
Apply To this Job