Prior Authorization Nurse
The prior authorization nurse is responsible for administering prospective reviews of authorization requests, which may include treatments, services, admissions, home care, and referrals. The nurses will also assist in preparing documentation, performing audits of patient records, and helping management with tasks as needed.
Job Duties and Responsibilities
- Provides clear documentation for approving requests
- Coordinate care and services for members
- Update clinical information utilizing various medical management systems
- Handles telephone requests in a timely and accurate manner
- Help with interdepartmental projects as needed
- Develop and update health plan resources and forms
- Provide training to prior authorization technicians
Education and Qualifications
- RN/LPN
- 2+ years clinical nursing experience in an intense care setting
- Experience with prior authorizations
- Basic knowledge of computers and working with software programs
- Excellent verbal and written skills
- Must be organized
- Should be a team player and have a great attitude
- Strong service orientation and professionalism