RN Job
Prior Authorization Nurse (RN or LVN) – West Covina
Job Description
The role of the Case Manager, Prior Authorization LVN is to promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization specialty referral requests.
The Case Manager, Prior Authorization LVN will review for appropriate care and setting, and following guidelines/policies, will approve services when indicated. If not indicated, they will forward requests to the appropriate physician or medical director with recommendations for other determinations, ensuring that the member is receiving the appropriate quality care in a preferred setting, while making sure regulatory guidelines are followed
Qualifications
Education and/or Experience:
- Graduate from an Accredited Nursing Program
- Active California Licensed Vocational Nurse license
- Minimum of 1 year of processing referrals and authorizations experience
- Knowledge of Healthcare and Managed Care preferred.
- Knowledge of NCQA, CMS, HSAG, and health plan requirements related to utilization management.
- Knowledgeable with the pre authorization process and workflow, with prior authorization experience preferred
- Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access and Power Point)Typing 30 WPM with accuracy
- Ability to deal with responsibility with confidential matters
- Ability to work in a multi-task, fast-paced, high-stress environment
About the Hospital
As one of the largest physician-led networks in Southern California, we have thousands of physicians and hundreds of hospitals committed to providing quality healthcare to all of the communities we serve.
Every day, our employees are inspired to make a difference in the lives of others as well as transform their own experiences to achieve a higher sense of fulfillment. Our employees become a part of an extraordinary team of people dedicated to health, wellness, and happiness for themselves and others. There is no greater reward than contributing to a positive work environment where compassion, understanding, care and attention are encouraged and valued.
