Prior Authorization Nurse (LVN or RN) TEMP

Job description

Position Summary: The role of the Case Manager, Prior Authorization Nurse 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. The Case Manager, Prior Authorization LVN will review for appropriate care and setting, and following guidelines/policies, will approve services when indicated. If not indicated, they will forward requests to the appropriate physician or medical director with recommendations for other determinations, ensuring that the member is receiving the appropriate quality care in a preferred setting, while making sure regulatory guidelines are followed. Essential Duties and Responsibilities include the following: The pay range for this position at commencement of employment is expected to be between for LVN's $37.50 - $40 for RN's $45 - $50 per hour ; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience. - Understand, promote and review with the principles of medical management to facilitate the right care at...