Prior Auth Registered Nurse

Immediate need for a talented Prior Auth Registered Nurse. This is a 01+ months contract opportunity with long-term potential and is located in U.S(Remote). Please review the job description below and contact me ASAP if you are interested. Job ID: 25-74793 Pay Range: $30 - $31/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

No direct patient care. This is a virtual position. Responsible for clinical criteria prior authorization setup, which takes client clinical policy requirements and creates the prior authorization request sent to prescribers. This could include questions such as (but not limited to) is the patient 18, does this patient have , has the patient tried and failed these alternative medications etc. The creation of questions and answers along with other additional configuration will allow prescribers to answer questions leading to either an approval or denial. Clinicians are also responsible for creating and coding denial rationales sent to prescribers and patients. The system leveraged for this coding is a web-based platform proprietary to ESI, and selected contractor will be trained on how to leverage this platform. Additionally, the individuals should have strong skills with Microsoft office, particularly excel. Configuration support will be for both pharmacy and medical criteria and will require good creative problem-solving skills to ensure appropriate setup to meet client needs and maximum operation efficiency. Consultative support in explaining setup and system requirements might be needed if discussing criteria setup with other internal ESI business partners. An individual with strong and effective communication skills is highly desired.