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Axelon Services Corporation
Clinical Review Nurse - Prior AuthorizationAxelon Services Corporation • Various, MO
Clinical Review Nurse - Prior Authorization

Clinical Review Nurse - Prior Authorization

Axelon Services Corporation • Various, MO
Less than 1 hour ago
Job type
  • Full-time
  • Quick Apply
Job description

Summary:

  • Work Mode: 100% Remote, Candidates with Central Time Zone highly preferred
  • Duration: 6 months, possible extension
  • Shift: 8am – 5pm CST Mon – Fri, Possible holiday shifts, OT as needed (needs approval)

Responsibilities:

  • Analyze all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage.
  • Provide recommendations to the appropriate medical team to promote quality and cost-effectiveness of medical care.
  • Consolidate clinical information into an easy-to-read summary.
  • Conduct medical necessity reviews with clinical information, using clinical policies and criteria.
  • Collaborate with Medical Directors.
  • Maintain adequate time management as the workload is high and can change throughout the day.
  • Work with transplant providers at the facilities to gather clinical information.
  • Ensure appropriate case management and contracting is in place for each transplant authorization.

Requirements:

  • Required Education/Certification: RN degree
  • Required Licensure: Current state RN license only (no LPNs)
  • Years of experience required: Minimum 3 years of Utilization Management/Prior Authorization experience
  • Disqualifiers: Not an RN, no PA and UM experience

Preferred Skills:

  • Prior Authorization experience
  • Compact Nursing License
  • Transplant Medical Necessity Review experience in a Utilization Management environment or Transplant Surgical experience
  • Correctly uses and interprets clinical policies and clinical review criteria to determine medical necessity
  • Proficiency in MS Suite and clinical software tools to manage clinical documentation systems
  • Maintains professional and courteous communication with providers and members
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Clinical Review Nurse - Prior Authorization • Various, MO

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