Outpatient Prior Authorization Nurse, Compact License Required

People are the most important asset of Imperial, for this reason the difference and plurality of people, equality of opportunities, non-discrimination and inclusion in the workplace are priority and strategic factors in the Organization. Imperial maintains a strong will to promote Diversity, Equity, and Inclusion, through inclusive leadership as a lever change and business sustainability.

Imperial Health Plan of California, Inc. is approved by California Department of Managed Health Care to offer full-service Medicare Advantage coverage, including a Medicare Advantage Prescription Drug plan, and a Chronic Condition Special needs plan over numerous counties in California. Through its affiliates, Imperial Insurance Companies and Imperial Health Plan of the Southwest, Imperial also offers covered services to eligible individuals under the Affordable Care Act-Obamacare in numerous counties in Texas, Utah, Nevada and Arizona.

Responsible to provide timely review of authorization requests meet national standards and contractual requirements. The prior authorization nurse will promote the quality and cost effectiveness of patient care using clinical acumen.

ESSENTIAL JOB FUNCTIONS:

1. Perform timely review of prior authorization requests for medical necessity by applying appropriate clinical criteria.

2. Provide accurate and complete documentation with rationale used to approve requests.

3. Collaborate with various staff within clinical services to coordinate patient care.

4. Provide appropriate interventions which demonstrate knowledge and sensitivity toward cultural diversity and religious, developmental, health literacy, and educational backgrounds of the population served. Use interpreter services as needed.

5. Enter and maintain clinical information in authorization systems.
6. Prepare case summaries and provide clinical criteria for cases that require MD reviews.

EDUCATION/EXPERIENCE:

· Minimum 1 year clinical nursing setting experience

· Prior authorization experience preferred

SKILLS/KNOWLEDGE/ABILITY:

· Knowledge of utilization management principles

· Prior authorization experience preferred

· Familiarity with Medi-Cal and Medicare guidelines

LICENSURE/CERTIFICATE/TRAINING:

· Active/Current, Unrestricted RN or LVN CA or TX license from an accredited school of nursing.

Job Type: Full-time

Pay: $42.00 - $44.00 per hour

Benefits:
• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Life insurance
• Paid sick time
• Paid time off
• Referral program
• Tuition reimbursement
• Vision insurance

Schedule:
• Day shift

License/Certification:
• RN (Required)
• LVN (Required)
• CA, AZ OR TX Licence (Required)

Work Location: Remote

Apply Job!