Job Description

Job Description

Immediate need for a talented UM Nurse/Prior Auth Nurse. This is a 06+months contract opportunity with long-term potential and is located in Phoenix, AZ (Remote) . Please review the job description below and contact me ASAP if you are interested.

Job ID:25-77859

Pay Range: $30 - $32/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Nurses review case files, add, update or edit authorizations.
• Work closely with the MD team to make final decisions on cases.
• The clinical team works closely with their supervisors and senior clinicians on the team for support.
• Team does have group chats on Teams for routine questions.
• Team works closely together along with the coordinator team who owns end to end process on cases.
• Team handles various types of authorization and claim review requests from various markets nationwide.
• Processing clinical reviews to ensure members have the best outcomes and access to care needed.
• Help reduce provider abrasion by processing retrospective claim reviews.

Key Requirements and Technology Experience:

• Key Skills:RN ,Prior Auth ,Claims .
• Medicare knowledge, InterQual or Milliman Experience, Clinical reviews for Utilization Management or Appeals.
• Medicare Appeals Experience.
• Associate in nursing, Bachelor’s in nursing or higher.
• RN, LPN .

Our client is a leading Healthcare Industry, and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

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