Prior Authorization Nurse- 226437
2 weeks ago
Medix is hiring a direct hire Prior Authorization LVN or RN with a great Healthplan in Chatsworth, CA
Please note this position is 100% remote, but training must be onsite in Chatsworth, CA, there are
no exceptions for remote training. (training typically is 2-3 weeks)
Location: Chatsworth California 91311 United States
Schedule: Monday-Friday 8:30am-5p
Average salary is: 65k-100K- we can talk through pay and what negotiating might look like
Summary of Position:
- The UM Prior Authorization Nurse is primarily responsible for reviewing referrals for medical
- services to determine medical necessity and course of action, by using their independent
- judgment and extensive knowledge of medicine, along with clinical guidelines. The UM Prior Authorization Nurse confers with Nursing Manager, VP of Clinical Policy and/or Medical Director whenever appropriate in utilization management or problem solving.
Essential Duties
- Reviews prior authorization referrals for medical necessity by:
- Exercising independent judgment and extensive knowledge of medicine.
- Independently reviewing and assessing records provided and determining how patient specifically meets criteria for services being requested.
- Ensuring all health plan, state and clinical guidelines are enforced in making
- of decision.
Approval Recommendations
- Developing clinical summary for why patient specifically meets criteria for services requested.
- Independently making decision to approve services requested.
- Denial Recommendations
- Developing clinical summary for why information provided does not show
- patient meeting criteria for services requested.
- Making recommendations for Medical Director’s review based on assessment
- of why information provided does not support patient meeting criteria for
- services requested.
Qualifications/Experience
- Bachelor’s or Associate Degree in Nursing (Bachelor’s preferred)
- Current CA State licensure as Registered Nurse (RN) or Licensed Vocational Nurse (LVN)
- At least 2 years of experience in a comparable position.
- Prior authorization or Managed Care experience preferred.
Skills
- Ownership/Dependability - Assumes responsibility for the accomplishment of goals
- and objectives by accepting ownership of assignments, adhering to established work
- schedules, practicing efficient time management to meet quality service goals and
- support team objectives. Willingness to be held accountable for errors.
- Attendance – Due to the nature of the department, must maintain excellent
- attendance and dependability.
- Attention to Detail – Must have ability to pay close attention to all details in medical records and clinical guidelines.
Job Description
- Business Acumen - Professionally represents Company in appearance and ability to display a professional and positive approach to a job.
- Physical Demands/Work Environment
- Must be able to work in a seated position for long periods of time
- Must be able to use fingers, hands and arms at computer keyboard for long periods of time
-
Prior Authorization Nurse- 226437
1 month ago
Los Angeles, United States Medix™ Full timeMedix is hiring a direct hire Prior Authorization LVN or RN with a great Healthplan in Chatsworth, CAPlease note this position is 100% remote, but training must be onsite in Chatsworth, CA, there are no exceptions for remote training. (training typically is 2-3 weeks) Location: Chatsworth California 91311 United StatesSchedule: Monday-Friday 8:30am-5pAverage...
-
Prior Authorization Nurse- 226437
1 month ago
Los Angeles, United States Medix™ Full timeMedix is hiring a direct hire Prior Authorization LVN or RN with a great Healthplan in Chatsworth, CAPlease note this position is 100% remote, but training must be onsite in Chatsworth, CA, there are no exceptions for remote training. (training typically is 2-3 weeks) Location: Chatsworth California 91311 United StatesSchedule: Monday-Friday 8:30am-5pAverage...
-
Registered Nurse, Prior Authorizations
2 weeks ago
, CA, United States Medix™ Full timeJob Title: Prior Authorizations Registered Nurse (RN)Summary:The UM Prior Authorization Nurse is responsible for evaluating referrals for medical services to determine medical necessity and appropriate course of action. Utilizing independent judgment, extensive medical knowledge, and adherence to clinical guidelines, the Prior Authorization Nurse...
-
Prior Authorization Coordinator
5 days ago
Los Angeles, California, United States Aston Carter Full timeDescription:The role of the Prior Auth Coordinator is to promptly, efficiently and accurately execute all aspects ofthe referral process. Facilitating the right care at the right time in the right setting. Process requestsfrom Access Express that are pended or reprocess approved or denied auths and package properly forreview and resolution. Check eligibility...
-
Prior Authorization Specialist
15 hours ago
Los Angeles, United States A-Line Staffing Solutions Full timeJob DescriptionJob DescriptionA-Line Staffing is now hiring a remote Prior Authorization Specialist with a major health plan company. This would be full time / 40+ hours per week.Prior Authorization Specialist CompensationThe pay for this position is $23 per hourBenefits are available to full-time employees after 90 days of employmentA 401(k) with a company...
-
Prior Authorization Coordinator
5 days ago
Los Angeles, California, United States Aston Carter Full timeDescription:The role of the Prior Auth Coordinator is to promptly, efficiently and accurately execute all aspects ofthe referral process. Facilitating the right care at the right time in the right setting. Process requestsfrom Access Express that are pended or reprocess approved or denied auths and package properly forreview and resolution. Check eligibility...
-
Los Angeles, California, United States Aston Carter Full timeLARGE MEDICAL GROUP IS HIRING PRIOR AUTHORIZATION COORDINATORSSTART DATE 3/28 $25/HR SCHEDULE: 8:30AM-5:30PM If you're interested please email resume to Description:The role of the Prior Auth Coordinator is to promptly, efficiently and accurately execute all aspects ofthe referral process. Facilitating the right care at the right time in the right setting....
-
Prior Authorization Supervisor
2 weeks ago
Cedar Rapids, IA, United States Physicians Clinic of Iowa Full timePLEASE COMPLETE THE EDUCATION AND WORK EXPERIENCE PROFILES AFTER ANSWERING THE APPLICATION QUESTIONSPhysicians’ Clinic of Iowa is seeking a Prior Authorization Supervisor for our outstanding Prior Authorization team. This is an excellent opportunity to join a team of highly dedicated medical professionals and staff whose primary mission is to provide high...
-
Prior
5 days ago
Los Angeles, California, United States Aston Carter Full timeHiring ASAP a PriorAuthorization Specialist paying $25/HRLocation: Northridge (100% Onsite)Description:The role of the Prior Auth Coordinator is to promptly, efficiently and accurately execute all aspects ofthe referral process. Facilitating the right care at the right time in the right setting. Process requestsfrom Access Express that are pended or...
-
Prior Authorization UM Nurse Consultant
2 weeks ago
Trenton, NJ, United States CVS Full timeFully remote Work from home anywhere in the US. Working hours will be Tuesday - Saturday 0800 AM - 5:00 PM EST; (training schedule 8 a-5 pm Est time). Holidays will be on rotation. No travel is required. Applicants from any state can apply. Prior Aut Nurse, Authorization, Consultant, Healthcare, Retail, Clinical, Benefits
-
Authorization Specialist
15 hours ago
Los Angeles, United States A-Line Staffing Solutions Full timeJob DescriptionJob DescriptionA-Line Staffing is now hiring an Remote Authorization Specialist. The Authorization Specialist would be working for a major company and has career growth potential This would be full time / 40+ hours per weekIf you are interested in this Authorization Specialist position, please contact Mitch at...
-
Clinical Authorization Specialist
1 month ago
Los Angeles, United States Keck Medical Center of USC Full timeThe Clinical Authorization Specialist will take the lead in securing medical authorizations from third party payers (commercial and government) for outpatient clinic, inpatient admission, ancillary services and/or chemotherapy and other infused treatments as needed in assigned service line. The Specialist will be instrumental in obtaining written...
-
Authorization Technician II
1 week ago
Los Angeles, United States L.A. Care Health Plan Full timeAuthorization Technician II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 11131 Salary Range: $47,840.00 (Min.) - $57,062.00 (Mid.) - $68,474.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California...
-
Authorization Technician II
2 months ago
Los Angeles, California, United States L.A. Care Health Plan Full timeSalary Range: $47, Min.) - $57, Mid.) - $68, Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members in five health plans, we make...
-
Patient Authorization Representative
2 weeks ago
Los Angeles, United States University of California Full timeDescription As a Patient Authorization Representative, you will be responsible for: Pre-encountering and pre-registering patients as well as providing registration support to patients, clinic staff, and managers Verifying insurance and enter insurance benefits information into the CareConnect system prior to appointments Determining co-pays and deductibles;...
-
Patient Authorization Representative
1 month ago
Los Angeles, United States CareerBuilder Full timeDescription As a Patient Authorization Representative, you will be responsible for: * Pre-encountering and pre-registering patients as well as providing registration support to patients, clinic staff, and managers * Verifying insurance and enter insurance benefits information into the CareConnect system prior to appointments * Determining co-pays and...
-
Authorization Technician II
2 weeks ago
Los Angeles, United States L.A. Care Health Plan Full timeAuthorization Technician II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 11131 Salary Range: $47,840.00 (Min.) - $57,062.00 (Mid.) - $68,474.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California...
-
Authorization Technician II
2 months ago
Los Angeles, United States L.A. Care Health Plan Full timeSalary Range: $47,840.00 (Min.) - $57,062.00 (Mid.) - $68,474.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million...
-
Pediatric Acute Care NP Content Author
2 weeks ago
Los Angeles, California, United States Blueprint Test Prep Full timeBlueprint is looking for Nurse Practitioner authors who will develop exceptional board-style questions and explanations for NP students and practicing clinicians Currently looking for board-certified NP authors in the following domains:PNP-AC (Acute Care) Blueprint accepts applications for this position on an ongoing basis.What You'll DoThis is a contract...
-
Psych-Mental Health NP Content Author
2 weeks ago
Los Angeles, California, United States Blueprint Test Prep Full timeBlueprint is looking for Nurse Practitioner authors who will develop exceptional board-style questions and explanations for NP students and practicing clinicians Currently looking for board-certified NP authors in the following domains:Psych-Mental Health NPBlueprint accepts applications for this position on an ongoing basis.What You'll DoThis is a contract...