Pacer Staffing LLC

Clinical Review Nurse - Prior Authorization

Pacer Staffing LLC United States
Pacer Staffing LLC

Clinical Review Nurse - Prior Authorization

Pacer Staffing LLC United States
6 days ago 87 applicants

See who Pacer Staffing LLC has hired for this role

Position Title: Clinical Review Nurse - Prior Authorization

Location: Remote

Duration: 12 Months

Schedule: Monday – Friday 8-5 EST

Pay rate: $30.00-35.00/hr

Job Description

Address any email correspondence, read Teams message for updates, view calendar for important meetings/huddles/training for day, may have up to 10-15 calls to providers daily,

Describe the performance expectations/metrics for this individual and their team:

  • Meets and Maintains productive standard (13-15+ Reviews/day)
  • Appropriately refers cases for secondary review as evidenced by appropriate benchmark range and quality audits- RN to MD Referral Rate
  • Meets and Maintain TAT performance (95%)
  • Quality reviews >/= 95% monthly
  • Demonstrated comprehension of criteria application (IQ/IQC/MCG; Pass IRR annually)
  • Understanding of Clinical Documentation System
  • Basic Excel Skills
  • Professional and courteous communication skills

Required Skills

  • Prior PA experience required
  • Experience in InterQual or Milliman
  • Organizational skills needed.

Education Requirement:  

  • LPN - Licensed Practical Nurse/RN

  • Seniority level

    Entry level

  • Employment type

    Full-time

  • Job function

    Health Care Provider

  • Industries

    Staffing and Recruiting

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