Job Description:

Medix is hiring a direct hire Prior Authorization LVN or RN with a great Healthplan in Chatsworth, CAPlease 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) Location: Chatsworth California 91311 United StatesSchedule: Monday-Friday 8:30am-5pAverage salary is: 65k-100K- we can talk through pay and what negotiating might look likeSummary of Position:The UM Prior Authorization Nurse is primarily responsible for reviewing referrals for medicalservices to determine medical necessity and course of action, by using their independentjudgment and extensive knowledge of medicine, along with clinical guidelines. The UM Prior Authorization Nurse confers with Nursing Manager, VP of Clinical Policy andor Medical Director whenever appropriate in utilization management or problem solving.Essential DutiesReviews prior authorization referrals for medical necessity by:Exercising independent judgment and extensive knowledge of dependently reviewing and assessing records provided and determining how patient specifically meets criteria for services being requested.Ensuring all health plan, state and clinical guidelines are enforced in makingof decision.Approval RecommendationsDeveloping clinical summary for why patient specifically meets criteria for services dependently making decision to approve services requested.Denial RecommendationsDeveloping clinical summary for why information provided does not showpatient meeting criteria for services requested.Making recommendations for Medical Director's review based on assessmentof why information provided does not support patient meeting criteria forservices requested.QualificationsExperienceBachelor's or Associate Degree in Nursing (Bachelor's preferred)Current CA State licensure as Registered Nurse (RN) or Licensed Vocational Nurse (LVN)At least 2 years of experience in a comparable position.Prior authorization or Managed Care experience preferred.SkillsOwnershipDependability - Assumes responsibility for the accomplishment of goalsand objectives by accepting ownership of assignments, adhering to established workschedules, practicing efficient time management to meet quality service goals andsupport team objectives. Willingness to be held accountable for errors.Attendance - Due to the nature of the department, must maintain excellentattendance and dependability.Attention to Detail - Must have ability to pay close attention to all details in medical records and clinical guidelines.Job DescriptionBusiness Acumen - Professionally represents Company in appearance and ability to display a professional and positive approach to a job.Physical DemandsWork EnvironmentMust be able to work in a seated position for long periods of timeMust be able to use fingers, hands and arms at computer keyboard for long periods of time