Prior Auth Nurse/ LPN/LVN

Job Title: Clinical Review Nurse - Prior Authorization Location: Remote with compact license Duration: 5 Months Contract to Hire Pay Range: $38-42 per Hour on W2, Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location). ======================================================================================= Walk me through the day-to-day responsibilities of this the role and a description of the project (Outside of Workday JD): Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care.Coordinates as appropriate with healthcare providers and interdepartmental teams, to assess medical necessity of care of member.Escalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of care.Assists with service authorization requests for a member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities.Collects, documents, and maintains all member’s clinical information in health management systems to ensure compliance with regulatory guidelines.Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to members.Provides feedback on opportunities to improve the authorization review process for members.Performs other duties as assigned.Describe the performance expectations/metrics for this individual and their team: Productivity of 15 decision authorizations per day Tell me about what their first day looks like: Sit with a current team member and shadow.Learn about TruCareSomeone will shadow the new hire on authorizations to ensure understanding. What previous job titles or background work will be in this role? Prior PA experience required, InterQual, Care Guidelines, State Policy Experience Required Skills/Experience: 1. Prior PA experience required 2. Experience in InterQual Milliman 3. Understanding state policies Education Requirement: Associates Software Skills Required: InterQual Milliman, Microsoft Office Required Certifications: LPN - Licensed Practical Nurse - State Licensure required Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria