PRIOR AUTHORIZATION NURSE

4 weeks ago


Chatsworth CA USA, United States Medix Full time
Title: Prior Authorization LVN OR RN

Schedule: Monday through Friday 8am-5pm

Pay: $33-50/hr (depending on experience)

Location: Remote after training (approx. 2-4 weeks)

Training is located 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)

Summary of Position:

The UM Prior Authorization Nurse plays a pivotal role in evaluating referrals for medical services to ensure their necessity and determine the appropriate course of action. Leveraging their expert judgment and comprehensive medical knowledge, along with adherence to clinical guidelines, they collaborate with stakeholders to facilitate optimal patient care.

Essential Duties:
  • Referral Review: Employing independent judgment and extensive medical expertise, assess referral requests for medical necessity, meticulously scrutinizing patient records to ascertain eligibility for requested services while ensuring compliance with health plan and state regulations.
  • Approval Recommendations: Craft detailed clinical summaries justifying the necessity of requested services, autonomously approving services when criteria are met.
  • Denial Recommendations: Develop comprehensive clinical summaries outlining reasons for denial based on assessment of provided information, making recommendations for review by the Medical Director when criteria are not met.

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).
  • Minimum of 2 years of relevant experience, preferably in prior authorization or managed care settings.

Skills:
  • Ownership and Dependability: Assumes accountability for assigned tasks, adheres to schedules, practices effective time management, and willingly accepts responsibility for outcomes.
  • Attendance: Maintains exemplary attendance and reliability due to the critical nature of the department's functions.
  • Attention to Detail: Possesses a keen eye for detail in analyzing medical records and adhering to clinical guidelines to ensure accuracy and quality.

#MedixWest

  • Los Angeles, CA, United States Medix™ Full time

    Medix 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...


  • , CA, United States Medix™ Full time

    Job 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...


  • 100 Clinton St, Camden, NJ 08103, USA, United States Cooper University Health Care Full time

    About us At Cooper University Health Care, our commitment to providing extraordinary health care begins with our team. Our extraordinary professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies and research protocols. We have a commitment to our employees by providing...


  • Chatsworth, United States Elite Medical Staffing Full time

    Job DescriptionJob DescriptionElite Medical Staffing is hiring Licensed Practical Nurses (LPNs) for open positions in GA. Successful candidates will have previous skilled nursing experience and a strong ability to apply clinical skills to new settings.About Us:Elite Medical Staffing is a nursing and allied healthcare staffing agency that matches top talent...


  • Chatsworth, United States Magnolia Gardens Skilled Nursing Facility Full time

    We are seeking to hire an IP Nurse to join our team! We are a skilled nursing facility looking for dynamic associates to join our clinical team and provide our residents with a best-in-class care experience! Whether you are just starting your career or have years of experience we want to meet you!The IP Nurse is responsible for the implementation of the...


  • Chatsworth, United States Elite Medical Staffing Full time

    Job DescriptionJob DescriptionAre you looking for a fulfilling role that challenges you and offers flexible scheduling? Are you passionate about delivering outstanding patient care in a fast-paced environment? If this is you, consider a rewarding opportunity with us today!Elite Medical Staffing is hiring Licensed Practical Nurses (LPNs) for open positions in...

  • Patient Access Rep II

    1 month ago


    Chatsworth, United States Alta Hospitals Full time

    The Patient Access Rep II arranges for the efficient and orderly admission of all inpatients and outpatients. Ensures that accurate patient information is collected and that patients are aware of hospital policy and procedures. Registers all patients according to department procedures. Completes all necessary admission (including consent) forms accurately...


  • Chatsworth, United States CEDARS-SINAI Full time

    Job Description A Clinical Nurse III, Oncology (CN III), is a proficient and expert clinician who provides nursing efficiently and effectively using a high standard of technical and organizational skills as well as critical thinking ability. Possesses an in depth knowledge in all aspects of nursing care for Oncology patient population and consistently...


  • Chatsworth, United States FlexCare Surgery Full time

    FlexCare Surgery is seeking a travel Physical Therapist for a travel job in Chatsworth, Georgia.Job Description & RequirementsSpecialty: Physical TherapistDiscipline: TherapyStart Date: ASAPDuration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: TravelSkilled Nursing FacilityFlexCare Surgery Job ID #JOB-01372215. Pay package is based on 8...


  • Chatsworth, United States FlexCare Surgery Full time

    Job DescriptionFlexCare Surgery is seeking a travel Physical Therapist for a travel job in Chatsworth, Georgia.Job Description & RequirementsSpecialty: Physical TherapistDiscipline: TherapyStart Date: ASAPDuration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: TravelSkilled Nursing FacilityFlexCare Surgery Job ID #JOB-01372215. Pay package is...


  • Chatsworth, United States FlexCare Surgery Full time

    FlexCare Surgery is seeking a travel Physical Therapist for a travel job in Chatsworth, Georgia.Job Description & RequirementsSpecialty: Physical TherapistDiscipline: TherapyStart Date: ASAPDuration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: TravelSkilled Nursing FacilityFlexCare Surgery Job ID #JOB-01372215. Pay package is based on 8...

  • Senior Buyer

    2 weeks ago


    Chatsworth, United States Trillium Staffing Full time

    Trillium Professional is now seeking a Senior Buyer - Aerospace for direct-hire! This position is in charge of managing inventories, placing and fulfilling orders, liaising with outside vendors, and providing manufacturing materials to support operations. will choose, bargain with authorized vendors, and issue purchase orders to fulfill the quantity and...

  • Senior Buyer

    21 hours ago


    Chatsworth, United States Trillium Staffing Full time

    Trillium Professional is now seeking a Senior Buyer - Aerospace for direct-hire! This position is in charge of managing inventories, placing and fulfilling orders, liaising with outside vendors, and providing manufacturing materials to support operations. will choose, bargain with authorized vendors, and issue purchase orders to fulfill the quantity and...


  • Chatsworth, United States Alta Hospitals Full time

    The Certified Nursing Assistant aids professional and technical nursing personnel primarily by accomplishing a variety of duties and procedures which are directly related to patient care.  Primary duties include taking and recording vital signs, assisting patients with hygiene and elimination, ensuring the safety of the patient, and maintaining a clean and...


  • Chatsworth, United States Alta Hospitals Full time

    The Certified Nursing Assistant aids professional and technical nursing personnel primarily by accomplishing a variety of duties and procedures which are directly related to patient care.  Primary duties include taking and recording vital signs, assisting patients with hygiene and elimination, ensuring the safety of the patient, and maintaining a clean and...

  • Quality Manager

    1 day ago


    Chatsworth, United States Machina Labs Full time

    **Company** Machina Labs, founded in 2019 by aerospace and auto industry veterans, is a smart manufacturing company based in Los Angeles, California. Enabled by advancements in artificial intelligence and robotics, Machina Labs is developing software-defined factories of the future. The mission of the company is to develop modular manufacturing solutions...


  • Chatsworth, GA, United States FlexCare Surgery Full time

    FlexCare Surgery is seeking a travel Physical Therapist for a travel job in Chatsworth, Georgia. Discipline: Therapy ~ Start Date: ASAP ~ Shift: 8 hours, days ~ Employment Type: Travel Skilled Nursing Facility FlexCare Surgery Job ID #JOB-01372215. Pay package is based on 8 hour shifts and 40 hours per week (subject to confirmation) with...

  • GAIN Service Worker

    1 week ago


    Chatsworth, United States JVS SoCal Full time

    Job Type Full-time Description SUMMARY: The GAIN Service Worker (GSW) is an integral part in the GAIN Program. A GSW provides comprehensive case management to GAIN participants to ultimately help participants achieve financial independence and secure full-time employment. The role of the GSW is to lead the participant through the GAIN process explaining how...

  • GAIN Service Worker

    19 hours ago


    Chatsworth, United States JVS SoCal Full time

    Job Type Full-time Description SUMMARY: The GAIN Service Worker (GSW) is an integral part in the GAIN Program. A GSW provides comprehensive case management to GAIN participants to ultimately help participants achieve financial independence and secure full-time employment. The role of the GSW is to lead the participant through the GAIN process explaining how...

  • Review Nurse

    2 weeks ago


    Northridge, CA, United States Regal Medical Group, Inc. Full time

    Job DescriptionPosition Summary:The role of the Nurse Reviewer is to promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization specialty referral requests as well as acute inpatient admission. The Nurse Reviewer will review for appropriate care and...