- Referral Review: Employing independent judgment and extensive medical expertise, assess referral requests for medical necessity, meticulously scrutinizing patient records to ascertain eligibility for requested services while ensuring compliance with health plan and state regulations.
- Approval Recommendations: Craft detailed clinical summaries justifying the necessity of requested services, autonomously approving services when criteria are met.
- Denial Recommendations: Develop comprehensive clinical summaries outlining reasons for denial based on assessment of provided information, making recommendations for review by the Medical Director when criteria are not met.
- Bachelor's or Associate Degree in Nursing (Bachelor's preferred).
- Current CA State licensure as Registered Nurse (RN) or Licensed Vocational Nurse (LVN).
- Minimum of 2 years of relevant experience, preferably in prior authorization or managed care settings.
- Ownership and Dependability: Assumes accountability for assigned tasks, adheres to schedules, practices effective time management, and willingly accepts responsibility for outcomes.
- Attendance: Maintains exemplary attendance and reliability due to the critical nature of the department's functions.
- Attention to Detail: Possesses a keen eye for detail in analyzing medical records and adhering to clinical guidelines to ensure accuracy and quality.
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Floater Specialist
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Outpatient Case Manager
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Inpatient Coordinator
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Inpatient Coordinator After Hours
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Case Manager Lead
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Regal Medical Group Northridge, United StatesJob Description · Position Summary: · The Lead, Inpatient Transfer Team Case Manager is responsible for the assessment, treatment planning, intervention, monitoring, evaluation and documentation on identified patients during an acute care episode. Assesses and develops a care pl ...
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Heritage Provider Network Northridge, United StatesJob DescriptionPosition Summary:The Lead Inpatient Transfer Case Manager is responsible for the assessment, treatment planning, intervention, monitoring, evaluation and documentation on identified patients during an acute care episode. Assesses and develops a care plan in collabo ...
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Case Manager Lead
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Regal Medical Group Northridge, United StatesJob Description · Position Summary: · The Lead, Inpatient Transfer Team Case Manager is responsible for the assessment, treatment planning, intervention, monitoring, evaluation and documentation on identified patients during an acute care episode. Assesses and develops a care pl ...
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Inpatient Coordinator
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Regal Medical Group Northridge, United StatesJob Description · Education and/or Experience: · High school graduate required; Associate in Arts degree preferred. · Knowledge of Healthcare and Managed Care preferred. · Typing 60 words per minutes with accuracy. · Knowledge of computers, faxes, printers and all other equipment ...
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Outpatient Coordinator Lead
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Regal Medical Group Northridge, United StatesJob Description · Position Summary: · The Outpatient Coordinator Lead is responsible for navigating the care management across the continuum of care of the member from acute to outpatient case management. The Outpatient Coordinator Lead's role is to incorporate administrative job ...
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Patient Access Representative
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Patient Access Representative
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Social Worker, MSW
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Social Worker, MSW
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Los Angeles Jewish Health Reseda, CA, United States Full timeThe Joyce Eisenberg-Keefer Medical Center is the Los Angeles Jewish Health's state-of-the-art skilled nursing medical center with 239 residents. We value our employees We offer long term employment opportunities with job stability, including supporting and encouraging career gro ...
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Per Diem
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Medical Assistant I
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Lvl III Staff RN
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Prior Authorization Nurse - Chatsworth, CA, United States - Medix
Description
Title: Prior Authorization LVN OR RNSchedule: Monday through Friday 8am-5pm
Pay: $33-50/hr (depending on experience)
Location: Remote after training (approx. 2-4 weeks)
Training is located in Chatsworth, CA
Please note this position is 100% remote, but training must be onsite in Chatsworth, CA, there are no exceptions for remote training. (training typically is 2-3 weeks)
Summary of Position:
The UM Prior Authorization Nurse plays a pivotal role in evaluating referrals for medical services to ensure their necessity and determine the appropriate course of action. Leveraging their expert judgment and comprehensive medical knowledge, along with adherence to clinical guidelines, they collaborate with stakeholders to facilitate optimal patient care.
Essential Duties:
