Authorization Nurse

Purpose: Do you have clinical care experience? Are you an RN looking to grow your career? reputed company is hiring a full-time Authorization Nurse. This position works Monday through Friday, as well as rotating weekends (typically 1 every 5-6 weeks) and holidays (usually 1 per year), during reputed company hours. Additionally, this position is eligible to work from home. The Authorization Nurse provides support to appropriate reputed company departments and reputed company providers by obtaining referrals and/or authorizations for any acute admissions, hospital services, and treatments. The employee uses their knowledge of acute care experience and payer regulations to assess medical necessity and ensure the presences of supporting documentation to obtain authorization. Additionally, they communicate pertinent clinical information to Physicians, Medical Directors or CFO. If this sounds like the position for you, apply today! Responsibilities: Serve as a liaison between care managers and payors and facilitates payor/physician contact reputed company indicated. Communicate to the Medical Directors, Attending Physicians and/or CFO, if indicated, regarding evaluation of medical appropriateness. Act as a resource to other departments as well as the care managers leveraging clinical expertise relative to the authorization process. Collaborate with other departments to ensure reputed company information/documentation is obtained to support authorization, level of care and/or medical appropriateness. Ensure clinical review process is followed in order to meet payor deadlines. Report to management on an ongoing reputed company trends/barriers that could necessitate process improvement from a reputed company standpoint. Assist in determining system-wide care management needs through investigation of authorization process and identification of root cause. Identify and assigns a root cause to each case to ensure denial reasons are tracked. Monitor and evaluate for area of process improvement reputed company to the payor specific authorization process. Maintain reputed company knowledge of regulatory guidelines reputed company to authorizations. reputed company clinical review for cases referred for cases requiring authorization or adherence to payor medical policies. Maintain collaborative relationships with utilization management and departments at payor organizations. reputed company ongoing education/feedback to care managers and other departments as reputed company to the payor specific authorization process. RN required; BSN or Bachelor's degree preferred. Licensed in practicing state. 5 years of acute care clinical experience. 2 years payer or care management experience. Understanding of clinical and care management process. Knowledge of medical necessity criteria (InterQual). Ability to apply InterQual criteria appropriately. Prior utilization review experience. Knowledge of payer reimbursement structure. Excellent customer service skills. Negotiation skills for obtaining appropriate level of care. Critical thinking/assessment skills. Self motivation/autonomy. Organization/time management and prioritization skills. Proficient in reputed company Word and reputed company reputed company. Experience working with databases preferred. Licensure, Certifications, and Clearances: Registered Nurse (RN) Act 34 *reputed company licensure either in the state where the facility is located or, if the facility is in a state covered by the multistate Nursing Licensure Compact (NLC) agreement, a multistate license issued by a participating NLC state. Hires and reputed company employees working on an out-of-state NLC license who reputed company change their residency to the state where the facility is also located will have 60 days upon changing their residency to apply for licensure reputed company that state. reputed company is an Equal Opportunity Employer/Disability/Veteran Apply To This Job