Clinical Review Nurse
Clinical Review Nurse
Pacer Staffing LLC
United States
Over 200 applicants
See who Pacer Staffing LLC has hired for this role
Job Title: Clinical Review Nurse
Location: Remote MO
Duration: 2 months
Shift Timing: Monday through Friday 8:00am to 5:00pm CST.
Some flexibility depending on the time zone, 9 - 6 7 - 4 10 -7 is also a last resort but an option.
Summary
Location: Remote MO
Duration: 2 months
Shift Timing: Monday through Friday 8:00am to 5:00pm CST.
Some flexibility depending on the time zone, 9 - 6 7 - 4 10 -7 is also a last resort but an option.
Summary
- Prior authorization nurse is supporting a Medicaid line of business.
- Reviewing outpatient service requests to determine if they are medically necessary.
- Reviewing cases in InterQual
- Working with medical directors and therapists
- Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage.
- Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care.
- Utilization management cases
- Fast paced environment
- 36 hours turnaround time from start to finish with utilization management cases. (Start to finish)
-
Seniority level
Entry level -
Employment type
Full-time -
Job function
Health Care Provider -
Industries
Staffing and Recruiting
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