Offer summary

Qualifications:

Registered Nurse (RN) with state licensure, Knowledge of medical terminology and Medicare regulations, Experience with prior authorization and applying nationally recognized criteria, Strong computer skills, including proficiency in Microsoft Office and electronic medical record systems..

Key responsabilities:

Review and authorize clinical form requests and referrals per compliance standards

Collaborate with Medical Directors on cases and potential denials

Assist non-clinical representatives with the Prior Authorization process

Document all prior authorization requests and maintain productivity.

Job description

Our Client, a Mutual Insurance Holding company, is looking for a Medical Review Nurse (RN) for their Remote location.

Responsibilities:

Review and authorize, as appropriate, phone/fax referral/authorization and clinical form requests per established criteria meeting compliance standards and timeframes
Review all requests not approved by the non-clinical support rep to determine benefit coverage and medical necessity
Review cases and potential denials with the Medical Directors
Research requests not clearly meeting established criteria
Assist the Prior Authorization non-clinical reps with the Prior Authorization process
Coordinate and maintain complete written documentation on all prior authorization’s requests.
Collaborate with other Florida Blue departments, such as Claims, UM, Quality, Disputes/Appeals, and other external vendors.
Log into phone queue to service providers
Answer inbound calls regarding authorizations within established time frame
Document contact information in electronic medical record system
Maintain productivity
Provide accurate prior authorization information to provider offices

Requirements:

Knowledge of medical terminology
Experience with prior authorization
Experience applying nationally recognized criteria, including InterQual
Knowledge of Medicare regulations and guidelines
Computer skills, including ability to use Microsoft Office suite
Previous experience within a call-center environment
Ability to navigate through multiple systems and screens to resolve authorization or medical review requests
Talking and typing simultaneously
Effective time management skills
Effective interpersonal and communication skills
Ability to use electronic medical record and claims systems
Problem solving abilities
Work cooperatively, positively, and collaboratively in an interdisciplinary team
Work respectfully and positively with others
Ability to manage multiple projects and prioritize work tasks to adhere to deadlines and identified time frames
Ability to think analytically and make decisions
Ability to manage large workload
0-2 years related work experience
Highschool Diploma or GED
RN - Licensed Practical Nurse - State Licensure

Why Should You Apply?

Health Benefits
Referral Program
Excellent growth and advancement opportunities

As an equal opportunity employer, ICONMA provides an employment environment that supports and encourages the abilities of all persons without regard to race, color, religion, gender, sexual orientation, gender identity or express, ethnicity, national origin, age, disability status, political affiliation, genetics, marital status, protected veteran status, or any other characteristic protected by federal, state, or local laws.

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