Clinical - Clinical Review Nurse - Prior Authorization Job at Pacer Group, Remote

RkJ6bXhTTWpBZVhnNkptMzRhV2htZW5WK3c9PQ==
  • Pacer Group
  • Remote

Job Description

Job Description:

Job Title: Clinical Review Nurse - Prior Authorization

Location: Remote - Central Time (CST)

Duration: 6 months (Possible Extension)

Shift Timing: Monday-Friday 8a-5p CST time

Job Summary:

Walk me through the day-to-day responsibilities of this role and a description of the project (Outside of Workday JD):

  • Medical Necessity Reviews using clinical criteria appropriate for the authorization
  • Clinical documentation in TruCare (clinical documentation system)
  • Sending second Level Reviews to Medical Directors
  • Provider outreach for additional information and/or notification (letter or phone calls)
  • Referrals for members with certain diagnosis (Case Management, Disease Management, etc.)

Describe the performance expectations/metrics for this individual and their team:

  • Turnaround Time Compliance
  • Quality Audit Scores 90%
  • Productivity Metrics
  • Nurse to MD referrals

Tell me about what their first day looks like:

  • System set up and then instructor led virtual training

What previous job titles or background work will in this role?

  • Utilization Management
  • Prior Authorization

Job Tags

Remote job, Shift work, Monday to Friday,

Similar Jobs

Western Digital

Enterprise Architect - IT Infrastructure Job at Western Digital

 ...some of the most storied advancements in memory and data storage technology to marketand our best, most innovative work is yet to come....  ...aligned with enterprise architecture standards. Stay informed on emerging technologies and assess their potential to enhance... 

LaSalle Network

Part-Time Entry-Level Recruiter Job at LaSalle Network

 ...and work alongside a team that brings fun and positivity into the office every day? If so, come join us as a Part-Time Entry-Level Recruiter ! We can accommodate a variety of part-time schedules, and we will provide you with the training you need to successfully screen... 

Microsoft

Director AI Silicon Product Management Job at Microsoft

 ...Azure drives advanced architecture and manages hardware roadmap planning and program management...  ...decisions. We are looking for a Sr. Director of AI Product Management to join our...  ...hardware strategy. Drive technical projects from requirements including managing complex... 

Gpac

Trust Officer Job at Gpac

Trust Officer This role is for a banking professional to service trusts and investments. This is a relationship-based role, where customers can span literal generations. This role can service private and corporate trust accounts. Trust Officer Qualifications:* Bachelor... 

Identifax Investigative Services

C Licensed Private Investigator Job at Identifax Investigative Services

"C" licensed Private Investigator - PART TIME (West Palm Beach - Ft. Lauderdale - Miami) THE BEST INVESTIGATORS WORK FOR THE BEST COMPANY...  ... Provide proof of license and insurance Have experience in Workers' Comp and Bodily Injury surveillance investigations...