Concurrent Review/Prior Authorization Nurse - Full-time / Part-time

Prior Authorization/Concurrent review/Utilization Review, Computer Savvy, Interqual experience , hardworking and a pleasant attitude, flexible.

Med/Surg experience preffered.

No UR experience required.

A team player!!*

This position will assist with the daily workflow for Inpatient authorizations, Prior Auth requests and Case Management Processes.

This position will help decrease risk of TAT for UM/PA and increase Case Management membership enrollment to promote desired positive outcomes.

Position Purpose: Review inpatient admissions to assure appropriate level of care and medical necessity.

Position Responsibilities:
Review admissions through on-site and telephonic review to ensure medical necessity and appropriate level of care.
Review and audit patient charts through on-site hospital visits.
Act as clinical resources to referral staff and make appropriate referrals.
Provide patient and provider education.
Data enters assessments, authorizations and reviews into the system.

No on-site, strictly UR (no patient contact). Reviews for DME (durable medical equipment), inpatient, outpatient throughout the state of GA. They use InterQual, liked that she had OB experience. Big on being a team player & making things fair so one person is not doing all the work. Denials go through medical director, her group does approvals. Communication with providers, assigned to particular facilities.

Position Purpose: Promote the quality and cost effectiveness of medical care by applying clinical
acumen and the appropriate application of policies and guidelines to emergent/urgent and continued
stay reviews. Education/Experience: Associate's degree in Nursing. Bachelor's degree in Nursing
preferred. 2+ years of clinical nursing experience in an acute care setting. Knowledge of healthcare
and managed care preferred. Licenses/Certifications: Current state's RN license.

Perform onsite review of emergent/urgent and continued stay requests for
appropriate care and setting, following guidelines and policies, and approve
services or forward requests to the appropriate Physician or Medical Director with
recommendations for other determinations

Complete medical necessity and level of care reviews for requested services using
clinical judgment and refer to Medical Directors for review depending on case findings

Collaborate with various staff within provider networks and discharge planning team
electronically, telephonically, or onsite to coordinate member care

Conduct discharge planning

Educate providers on utilization and medical management processes

Provide clinical knowledge and act as a clinical resource to non-clinical team staff

Enter and maintain pertinent clinical information in various medical management
systems

About Aerotek:

Aerotek, headquartered in Hanover, Md., is a leading provider of technical, professional and industrial staffing services. Established in 1983, Aerotek is an operating company of Allegis Group, the largest provider of staffing services in the U.S. Aerotek operates a network of more than 200 non-franchised offices throughout the U.S., Canada and Europe. For more information, visit .

Aerotek is acting as an Employment Agency in relation to this vacancy.