Clinical Review Nurse-Prior Authorization

4 weeks ago


Arlington, United States 10bits Full time
10bits is a Healthcare and Professional Staffing Company. From nursing staffing, temp to hire, and permanent to healthcare contracts, 10bits provides hospitals and medical facilities with high-quality clinical professionals with the highest standards and compliance to provide the best medical care.

Job Title: Clinical Review Nurse-Prior Authorization

Job Location: Arlington, FL - Remote ( Must reside in Florida )

Job Type: Contract - 6 Months

Job Duties:
* Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria.
* 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.

Job Requirements:
* LPN or RN
* Must reside in Florida.

Schedule:
* 9 AM to 6 PM

Nurse01

Job Type: Contract

Pay: $30.00 - $40.00 per hour

Schedule:
* 8 hour shift
* Day shift

License/Certification:
* LPN or RN (Required)

Location:
* Arlington, FL (Required)

Work Location: Remote

  • Arlington, United States MEDICAL FACULTY ASSOCIATES Full time

    The GW Medical Faculty Associates (MFA) was incorporated in July 2000 as a not-for-profit, physician-led practice group. The organization functioned as an independent organization in support of The George Washington University School of Medicine and Sciences as a multi-specialty physician practice group. The GW MFA has grown to become the largest independent...


  • Arlington, United States MFA Co Full time

    The GW Medical Faculty Associates (MFA) was incorporated in July 2000 as a not-for-profit, physician-led practice group. The organization functioned as an independent organization in support of The George Washington University School of Medicine and Sciences as a multi-specialty physician practice group. The GW MFA has grown to become the largest independent...


  • Arlington, United States MFA Co Full time

    The GW Medical Faculty Associates (MFA) was incorporated in July 2000 as a not-for-profit, physician-led practice group. The organization functioned as an independent organization in support of The George Washington University School of Medicine and Sciences as a multi-specialty physician practice group. The GW MFA has grown to become the largest independent...

  • Zoning Plan Reviewer

    2 months ago


    Arlington, United States Arlington County, VA Full time

    **Position Information**: Join our Community Planning, Housing and Development (CPHD) team and play an important role in the planning and development process for Arlington County! We are seeking** **a** Zoning Plan Reviewe**r** to provide critical technical and administrative support which includes reviewing by-right residential and commercial developments,...


  • Arlington, United States Capitol Bridge Full time

    About Capitol Bridge Founded in 2012, Capitol Bridge is based in Arlington, Virginia and is an SBA 8(a) Certified Small Disadvantaged Business with proven expertise providing independent medical reviews, records/data management services, medical coding, administrative staffing, and eligibility reviews. Capitol Bridge LLC is currently seeking a dynamic and...

  • Clinic Aide

    3 weeks ago


    Arlington, United States Arlington County, VA Full time

    **Position Information**: Arlington County's Department of Human Services is seeking a **Clinic Aide** to assist with providing services for the Behavioral Healthcare Division (BHD). BHD provides outpatient psychiatric services including health and wellness assessments, education and targeted intervention to seriously mentally ill adults and their...

  • Clinical Psychologist

    2 weeks ago


    Arlington, United States US Field Operating Offices of the Office of the Secretary of the Army Full time

    **Duties**: - Serve as medical case analyst and voting member on Army Review Boards Agency boards on cases involving behavioral health-related issues. - Advise the Senior Medical Advisor on activities and functions pertaining to the evaluation of service-connected behavioral health issues and psychological health programs and projects. - Provide medical...


  • Arlington Heights, United States Edward-Elmhurst Health Full time

    Position Highlights: - Sign on bonus: (if applicable) - Position: - Location: [City, IL] - Full Time/Part Time: [Full Time / Part Time] - Hours: Monday-Friday, [hours and flexible work schedules] - Required Travel: A Brief Overview: Reporting to the Specialty Management team, the Ambulatory Specialty Medication Access Coordinator works with Specialty...


  • Arlington, United States US Department of the Air Force - Agency Wide Full time

    **Duties**: **For additional information on direct hire opportunities with the Air Force please click **here**.** - Provides financial planning, budgeting, and execution for Program Management Offices within the F-35 Joint Program Office (JPO). - Integral member of multiple integrated project teams (IPTs) providing decision support and financial...


  • Arlington, United States RehabCare Full time

    Clinical Supervisor/Charge Nurse (RN)Clinical Supervisor/Charge Nurse 3p-11p Shift A career at Texas Rehabilitation Hospital of Arlington, a 40-private bed, state-of-the-art inpatient acute rehabilitation hospital operated as a tri-venture with Lifepoint Health, Texas Health Resources and Methodist Hospital System, is more than a job. It's a chance to be a...


  • Arlington, United States Texas Rehabilitation Hospital of Arlington Full time

    Clinical Supervisor/Charge Nurse (RN)Description Clinical Supervisor/Charge Nurse 3p-11p Shift A career at Texas Rehabilitation Hospital of Arlington, a 40-private bed, state-of-the-art inpatient acute rehabilitation hospital operated as a tri-venture with Lifepoint Health, Texas Health Resources and Methodist Hospital System, is more than a job. It's a...

  • Medication Technician

    4 weeks ago


    Arlington Heights, United States Northshore Full time

    GENERAL SUMMARY: Reporting to the assigned Clinical Supervisor, performs prescription refills and medication prior authorizations following designated protocols, under the direction of the Physician (MD) and Registered Nursing (RN). REPRESENTATIVE FUNCTIONS: Refills routine prescription requests following designated prescription refill protocols from...

  • Clinical Hub Lead

    3 weeks ago


    Arlington, United States Res-Care, Inc. Full time

    Our Company PharMerica Overview Join our PharMerica team! PharMerica is a closed-door pharmacy where you can focus on fulfilling the pharmaceutical needs of our long-term care and senior living clients. We offer a non-retail pharmacy environment. Our organization is in high growth mode, which means advancement opportunities for individuals who are looking...

  • Clinical Hub Lead

    2 weeks ago


    Arlington, United States Res-Care, Inc. Full time

    Our Company PharMerica Overview Join our PharMerica team! PharMerica is a closed-door pharmacy where you can focus on fulfilling the pharmaceutical needs of our long-term care and senior living clients. We offer a non-retail pharmacy environment. Our organization is in high growth mode, which means advancement opportunities for individuals who are looking...

  • Senior Buyer

    4 weeks ago


    Arlington, United States UnitedHealth Group Full time

    63%Processes requisition, reviews approval authority, identifies and selects vendors for supplies or equipment that require extensive or specialized knowledge and experience. Issues purchase orders and performs complex problem solving in relation to Clinic, Buyer, Senior, Health, Vendor, Evaluation, Healthcare

  • Registered Nurse MPS

    1 month ago


    Arlington, United States Mount Auburn Hospital Full time

    Job Type: RegularTime Type: Part timeWork Shift: Day (United States of America)FLSA Status: Non-ExemptWhen you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.Job Type:RegularScheduled Hours:16Work Shift:Day (United States of America)Registered Nurse, MPSJob Description:Obstetrics/Gynecology Office...


  • Arlington, Virginia, United States Department Of The Air Force Full time

    Summary Information regarding opportunities, how to submit your resume and your contact information is located on the Air Force Civilian Careers LinkedIn site.The Air Force Office of Scientific Research (AFOSR) seeks to fill the mid-level, DO/DR-03 position of Office of Research and Technology Applications (ORTA) Specialist/Support Agreement Manager (SAM)...


  • Arlington, Virginia, United States International Consulting Associates Inc Full time

    Principal Epidemiologist (PhD) - International Consulting Associates, Inc. (Remote)About ICAInternational Consulting Associates, Inc. is a rapidly growing company, located in the D.C./Metro area. We were founded in 2009 to assist firms with evaluating and achieving their objectives. We have become a trusted advisor helping our clients by offering...


  • Arlington, Virginia, United States International Consulting Associates Inc Full time

    Principal Epidemiologist (PhD) - International Consulting Associates, Inc. (Remote)About ICAInternational Consulting Associates, Inc. is a rapidly growing company, located in the D.C./Metro area. We were founded in 2009 to assist firms with evaluating and achieving their objectives. We have become a trusted advisor helping our clients by offering...


  • Arlington, United States Catalyst Health Group: Clinical Careers Full time

    Job DescriptionFamily Healthcare Associates (now a part of Catalyst Health Group) is seeking a Front Office Representative. Efficiently and effectively handles patient flow for the Primary Care Medical Practitioners at Family Healthcare Associates. They are responsible for greeting and directing patients and visitors to the clinic, assisting with patient...