Prior Authorization RN

3 weeks ago


Jacksonville, Florida, United States OpTech Full time

About Our Company: OpTech is dedicated to providing innovative solutions for the healthcare industry. We value employee growth, encourage collaboration, and offer a comprehensive benefits package that includes health and dental insurance, training opportunities, flexible work arrangements, and a competitive salary range.

Job Description:

As a Medical Review Nurse LPN, you will be responsible for reviewing and authorizing requests for services, communicating with healthcare providers and members, and making decisions based on established policies and procedures. This position requires reviewing phone and fax referrals, conducting research on cases, and coordinating with other departments to ensure efficient service delivery.

Responsibilities:
  • Review requests for services against established criteria
  • Research cases that don't meet established criteria
  • Maintain accurate documentation for prior authorization requests
  • Collaborate with various departments, including Claims, Utilization Management, Quality, Disputes/Appeals, and external vendors
Requirements:
  • Demonstrated knowledge of medical terminology
  • Experience with prior authorization and nationally recognized clinical guidelines
  • Familiarity with Medicare regulations and guidelines
  • Proficiency in computer applications, including Microsoft Office suite
  • Prior experience in a call-center environment or similar setting
Education and Licenses:
  • High School Diploma or equivalent
  • RN - Licensed Practical Nurse - State Licensure

Estimated Salary: $62,500 per year.



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