Prior Authorizations Nurse to $56k+ - – Phoenix

Large medical consulting group seeking qualified Prior Authorization Nurses. Duties include: Receive, review, verify, and process requests for referrals, diagnostic testing, inpatient admissions, outpatient procedures/testing, emergency room notification, home health care services, pharmacy pre-authorization edits, and durable medical equipment/supplies. Review pre-authorization and referral requests for medical appropriateness by using established clinical protocols to determine the medical necessity of the request. Investigate member history, clinical history, and eligibility as appropriate; contact case managers and medical service personnel to gather further information.Serve as advisor to team on pre-authorization reviews of cases with complexities falling outside of normal authorization protocols and guidelines.Current RN/LPN license in the State of Arizona required. Current malpractice coverage is necessary. Incumbent must have varied clinical experience, and demonstrated Utilization Review or Prior Authorization experience. Previous managed health care experience highly desirable. Experience with QMACS preferred.Please forward resumes to PJ


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Salary: 45000 - 55000