RN Prior Authorization - Austin, TX

Only for registered members Austin, TX, United States

2 days ago

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Job summary

The Registered Nurse conducts pre-service, concurrent/ retrospective reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.



Responsibilities


  • Makes outbound calls to the provider as required to gather additional information that may be needed

  • Utilizes client specific criteria sets, applicable client specific medical policy and client clinical guidelines for decision making to either approve or summarize and route to the clients nursing reviewer and/or clients medical staff for review

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