The Patient Care Authorization Nurse assesses medical necessity of procedures and/or admissions, conducts pre-certification or authorization, and monitors compliance with established guidelines. Coordinates with care providers and plan members with the goal of maximizing member benefits while managing costs. Being a Patient Care Authorization Nurse interprets benefits and guides members to choose to the appropriate providers, projects and resources. Assists members in appeals for denied services. In addition, Patient Care Authorization Nurse typically requires a special degree of Nursing or it ...s equivalent. Typically reports to a manager. Requires RN license. Working as a Patient Care Authorization Nurse typically requires 3-5 years of related experience. Gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work.More Show Less
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