Clinical - Clinical Review Nurse - Prior Authorization
Clinical - Clinical Review Nurse - Prior Authorization
Posted on :
20-10-2024
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Job Description
Job Description:
Job Title: Clinical Review Nurse Prior Authorization
Location: Remote
Duration: 12 months (Possible Extension)
Shift Timing: MondayThursday & Saturday (7AM 6PM)
Walk me through the daytoday responsibilities of this the role and a description of the project (Outside of Workday JD):
- Performing redirections for our nonpar auth requests. When our team gets a request from a provider who is not contracted with Ambetter our team must attempt to find an in network provider to redirect the member to and document this in the authorization. Will be making phone calls and talking to provider offices to see if they can accept the member.
Describe the performance expectations/metrics for this individual and their team:
- Once trained they should be able to redirect 1012 authorizations per day.
Tell me about what their first day looks like:
- Getting all systems set up and meeting with their preceptor. They will attend our learning journey first for about 4 weeks and then train with a preceptor on our team.
What previous job titles or background work will in this role
- Call Center
- LVN/LPN/RN nursing exp
Employment Type
Full Time
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