Prior Authorization RN
Location: NEWARK, NJ, USA
Salary: $35.00 USD Hourly - $39.00 USD Hourly
Description
Job Title: Prior Authorization Registered Nurse (RN)
Location: Remote (Candidates must reside in NJ, PA, NY, MD, or CT)
Schedule: Monday-Friday, 8:00 AM - 5:00 PM EST
Caseload: 10-35 cases per day, depending on demand
Job Overview
This role is responsible for ensuring patients receive appropriate, high-quality, and cost-effective care throughout their healthcare journey. The RN will assess medical appropriateness, coordinate patient care, advocate for members, and ensure compliance with established guidelines.
Key Responsibilities
• Prior Authorization & Medical Appropriateness: Evaluate clinical needs against guidelines to determine the medical necessity of inpatient stays, services, and procedures.
• Care Coordination & Planning: Develop and implement patient care plans, facilitating seamless care transitions and service delivery.
• Quality & Cost-Effectiveness: Monitor and optimize care to ensure adherence to clinical guidelines and positive patient outcomes. Participate in quality improvement initiatives.
• Patient Advocacy: Support members and families, coordinate resource utilization, and assess services across various healthcare settings.
• Program Referrals & Compliance: Encourage member participation in case and disease management programs through appropriate referrals.
• Documentation & Communication: Maintain accurate documentation and facilitate efficient communication with multidisciplinary teams through telephonic and in-person interactions.
• Fiscal Accountability: Ensure responsible resource utilization while supporting self-care outcomes and maintaining financial responsibility.
Qualifications
• Active NJ or Compact RN license
• Reside in NJ, PA, NY, MD, or CT
• Minimum of 3 years of clinical RN experience
• At least 2 years working in a Health Plan within Prior Authorization or Utilization Review
• Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint) and other Windows-based software
• Strong understanding of hospital structures and payment systems
• Knowledge of case, care, and disease management principles and operations
By providing your phone number, you consent to: (1) receive automated text messages and calls from the Judge Group, Inc. and its affiliates (collectively "Judge") to such phone number regarding job opportunities, your job application, and for other related purposes. Message & data rates apply and message frequency may vary. Consistent with Judge's Privacy Policy, information obtained from your consent will not be shared with third parties for marketing/promotional purposes. Reply STOP to opt out of receiving telephone calls and text messages from Judge and HELP for help.
Contact: [email protected]
This job and many more are available through The Judge Group. Find us on the web at www.judge.com
Apply Now
Apply Now
Salary: $35.00 USD Hourly - $39.00 USD Hourly
Description
Job Title: Prior Authorization Registered Nurse (RN)
Location: Remote (Candidates must reside in NJ, PA, NY, MD, or CT)
Schedule: Monday-Friday, 8:00 AM - 5:00 PM EST
Caseload: 10-35 cases per day, depending on demand
Job Overview
This role is responsible for ensuring patients receive appropriate, high-quality, and cost-effective care throughout their healthcare journey. The RN will assess medical appropriateness, coordinate patient care, advocate for members, and ensure compliance with established guidelines.
Key Responsibilities
• Prior Authorization & Medical Appropriateness: Evaluate clinical needs against guidelines to determine the medical necessity of inpatient stays, services, and procedures.
• Care Coordination & Planning: Develop and implement patient care plans, facilitating seamless care transitions and service delivery.
• Quality & Cost-Effectiveness: Monitor and optimize care to ensure adherence to clinical guidelines and positive patient outcomes. Participate in quality improvement initiatives.
• Patient Advocacy: Support members and families, coordinate resource utilization, and assess services across various healthcare settings.
• Program Referrals & Compliance: Encourage member participation in case and disease management programs through appropriate referrals.
• Documentation & Communication: Maintain accurate documentation and facilitate efficient communication with multidisciplinary teams through telephonic and in-person interactions.
• Fiscal Accountability: Ensure responsible resource utilization while supporting self-care outcomes and maintaining financial responsibility.
Qualifications
• Active NJ or Compact RN license
• Reside in NJ, PA, NY, MD, or CT
• Minimum of 3 years of clinical RN experience
• At least 2 years working in a Health Plan within Prior Authorization or Utilization Review
• Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint) and other Windows-based software
• Strong understanding of hospital structures and payment systems
• Knowledge of case, care, and disease management principles and operations
By providing your phone number, you consent to: (1) receive automated text messages and calls from the Judge Group, Inc. and its affiliates (collectively "Judge") to such phone number regarding job opportunities, your job application, and for other related purposes. Message & data rates apply and message frequency may vary. Consistent with Judge's Privacy Policy, information obtained from your consent will not be shared with third parties for marketing/promotional purposes. Reply STOP to opt out of receiving telephone calls and text messages from Judge and HELP for help.
Contact: [email protected]
This job and many more are available through The Judge Group. Find us on the web at www.judge.com
Apply Now
Apply Now