Prior Authorization Nurse I
Location: Jackson, Mississippi
Description: Magnolia Health Plan is employing Prior Authorization Nurse I right now, this vacancy will be reside in Mississippi. More complete informations about this vacancy opportunity please read the description below.
- Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests.
- Perform telephonic review of prior authori zation requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations
- Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings
- Collaborate with various staff within provider networks and case management team electronically or telephonically to coordinate member care
- Educate providers on utilization and medical management processes
- Provide clinical knowledge and act as a clinical resource to non-clinical team staff
- Enter and maintain pertinent clinical information in various medical management systems
Qualifications:
Education/Experience: Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferre d. 2+ years of clinical nursing experience. Knowledge of healthcare and managed care preferred.
Licenses/Certifications: Current State LPN/LVN or RN license.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Education/Experience: Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferre d. 2+ years of clinical nursing experience. Knowledge of healthcare and managed care preferred.
Licenses/Certifications: Current State LPN/LVN or RN license.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
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This vacancy starts available on: Thu, 03 May 2018 01:51:53 GMT