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Utilization Review - Prior Authorization-Columbia Job Details

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Company:  Nurse Resolutions
Job Code:  1475
Categories:  Skilled Nursing / Nursing Home (SNF)
Job Role:  Other
Country:  United States
Region/Province:  South Carolina (SC)
City:  Columbia
Job Description:   

Position Purpose:      

Perform utilization review for outpatient services

 Knowledge/Experience:  

At least two years clinical nursing experience.  Managed care experience preferred.  PC literate and familiar with Microsoft Office applications (Outlook, Word, Excel).

 Competencies:

Knowledge Worker: Integrity, Flexibility, Communication, Critical Thinking, Customer Focus, Decision Making, Planning and Organizing, Building Strategic Working Relationships, Technical and Professional Knowledge

 Position Responsibilities:

Review prior authorization requests utilizing approved criteria/guidelines to ensure the medical necessity of requested services/procedures.
Gather, collect, and document information necessary for the review of prior authorization requests received via fax or telephone from providers into designated systems according to procedure.
Refer cases not meeting criteria/guidelines for physician review.
Communicate review outcomes to providers per protocol.
Act as a clinical resource to referral staff.
Provide patient and provider education.

 Licenses/Certifications: 

RN, LPN or LVN required.  .


 

Abe Ghebrehiwet

Senior National Account Executive

Nurse Resolutions

888.411.2228 ext 204. Toll Free

407.557.2270. Fax

www.nurseresolutions.com



 

 

"Nursing solutions built for longevity."

 

 Job Function: Utilization Review Nurse- Prior Authorization

City: Indianapolis
Post Date:  05/24/2012
Apply Here

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