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Registered Nurse - Prior Authorization - Madison

Verona, WI

Job Description
Registered Nurse - Prior Authorization

Madison , Wisconsin

Madison is the state capital of Wisconsin. Located just west of Milwaukee, in Dane County, it is the second-largest city in Wisconsin. Madison is consistently ranked near the top of the "best places to live" list. With a low unemployment rate, Madison is a great place for talented healthcare professionals to live. Whether you prefer to work in a hospital, clinic, home care or senior housing setting - Madison job opportunities in healthcare are abundant.

Are you ready to join a company that is changing the face of health care across the nation? Our client is looking for a Registered Nurse to promote the quality and cost effectiveness of medical care by applying clinical knowledge and the appropriate application of policies and guidelines to prior authorization requests. As a new team member, you'll join a team dedicated to improving the lives of members.

Registered Nurse - Prior Authorization Responsibilities:

  • Perform telephonic review of prior authorization 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

Registered Nurse - Prior Authorization Qualifications:

  • Graduate from an Accredited School of Nursing
  • Bachelor's degree in Nursing preferred
  • 2+ years of clinical nursing experience
  • Knowledge of healthcare and managed care preferred.
  • Current RN license.
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