Prior Authorization Nurse
Company: VirtualVocations
Location: Sunnyvale
Posted on: November 7, 2024
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Job Description:
A company is looking for a Prior Authorization Medical Clinician
to evaluate and approve requested services based on medical
necessity criteria.
Key Responsibilities
Review cases for medical necessity and ensure adherence to
organizational policies
Document necessary information in the health plan's utilization
management system
Collaborate with internal and external stakeholders to support
program effectiveness
Required Qualifications
Bachelor's Degree in Nursing or equivalent relevant work
experience
At least 3 years of experience in an acute care or health insurance
environment
Minimum of 2 years of experience in pre-authorization or
utilization review
Current unrestricted licensure as a Registered Nurse
CCM Certification preferred
Keywords: VirtualVocations, Rancho Cordova , Prior Authorization Nurse, Healthcare , Sunnyvale, California
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