Pre-Authorization Nurse

Overview

• The Pre-Authorization Nurse role offers a structured work environment focused on care management and utilization management within managed care settings.
• This position involves processing service requests in compliance with Medicare and Medicaid guidelines and departmental criteria.
• Collaborate with interdisciplinary teams to ensure timely and accurate provision of services to members.
• Coordinate assessments and update individualized care plans to reflect members' current conditions.
• Ideal for experienced managed care RNs seeking a structured role without heavy caseload management.
• Telework available after completing initial orientation and training period.
• Opportunity to work remotely while contributing to impactful healthcare delivery.

Key Responsibilities & Duties

• Process service requests adhering to Medicare and Medicaid guidelines and departmental criteria.
• Collaborate with care managers, assessment nurses, and physicians to ensure timely service provision.
• Coordinate completion of assessments to accurately reflect members' current conditions.
• Maintain and update individualized care plans to align with members' needs and statuses.
• Utilize strong assessment skills to support care management processes effectively.
• Apply knowledge of utilization management processes and standards of medical practice.
• Ensure compliance with healthcare delivery systems and regulatory requirements.

Job Requirements

• Associate of Applied Science (AAS) in Nursing required; Bachelor's degree preferred.
• Minimum three to five years of nursing experience in long-term care, managed care, or geriatrics.
• Prior experience in interdisciplinary service delivery environments preferred.
• Working knowledge of Medicare and Medicaid regulations and utilization management processes.
• Proficiency in Windows, Word, and Excel applications.
• Strong assessment skills and familiarity with InterQual criteria.
• Ability to work remotely after completing initial training period.