California Licensed Prior Authorization Nurse

Job Summary

A company is looking for a UM Prior Authorization Nurse, RN (Work from Home).

Key Responsibilities

• Evaluate and process prior authorization requests for medical services based on clinical guidelines
• Serve as a liaison between healthcare providers, patients, and health plans to facilitate the authorization process
• Accurately document all authorization-related activities and ensure compliance with regulations and guidelines

Required Qualifications

• Active California license as a Registered Nurse (RN)
• Minimum 2 years of clinical nursing experience, preferably in utilization management or prior authorizations
• Familiarity with insurance authorization processes and medical billing
• Experience with EMR systems and prior authorization platforms
• Proficient in Microsoft Office Suite (Word, Excel, Outlook)