Pacer Staffing LLC

Clinical Review Nurse

Pacer Staffing LLC United States
Pacer Staffing LLC

Clinical Review Nurse

Pacer Staffing LLC United States
3 months ago
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

  • 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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