Clinical Review Nurse - Only in Indiana

BC Forward is looking for Clinical Review Nurse - Prior Authorization - 100% Remote (Must reside in Indiana)Position Title: Clinical Review Nurse - Prior AuthorizationLocation:  Remote (Must reside in Indiana)Duration: 03 months of contract with extension and contract to hirePayrate: $42.50/hrShift Timings: Monday-Friday, 8 am-5pm ESTShift Stays at 40H a week Must Have:Required: Bachelor’s degree in nursing and 2 – 4 years of related experience.Required: .RN, BSN, LPN, compact licenseMicrosoft Office, Data EntrySense of urgencyAccountableTyping: More than 50 WPMUtilization Management experienceAcute care experience Position Purpose:Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage. Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care. Education/Experience:Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience.Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred.Knowledge of Medicare and Medicaid regulations preferred.Knowledge of utilization management processes preferred. License/Certification:LPN - Licensed Practical Nurse - State Licensure requiredFor Health Net of California: RN license requiredFor Superior Health Plan: RN license required ResponsibilitiesPerforms medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteriaWorks with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized careCoordinates as appropriate with healthcare providers and interdepartmental teams, to assess medical necessity of care of memberEscalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of careAssists with service authorization requests for a member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilitiesCollects, documents, and maintains all member’s clinical information in health management systems to ensure compliance with regulatory guidelines Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to membersProvides feedback on opportunities to improve the authorization review process for membersPerforms other duties as assignedComplies with all policies and standardsCompany DescriptionAbout BCforward:Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward’s 6,000 consultants support more than 225 clients globally.BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class places to work.BCforward is an equal opportunity employer.

Salary : $43