RN Prior Authorization

Are you an experienced RN Prior Authorization looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions – this is the position for you!

Daily Responsibilities:

• Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests.

• Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations

• Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings

• Collaborate with various staff within provider networks and case management team electronically or telephonically to coordinate member care

• Educate providers on utilization and medical management processes

Hours for this Position:

• Monday- Friday; 8AM-5PM

• Pay rate starts at $30 per hour

Advantages of this Opportunity:

• Competitive salary, negotiable based on relevant experience

• Benefits offered, Medical, Dental, and Vision

• Fun and positive work environment

• RN licensure

• Candidates must have a car- mass transportation in Boston doesn’t go to Waltham

• 2+ years of clinical nursing experience

• Some sort of Prior Authorization experience from either another managed care company or clinical setting

Interested in being considered?

If you are interested in applying to this position, please contact (Katleen Angala, 321-445-8243) and click the Green I’m Interested Button to email your resume.