Healthcare Consultant-Prior Authorization Nurse - Tampa Florida

Location: Tampa, Florida
Posted On: 05/10/2025

Temp 2-4 months

Pay - $21.38 +



GENERAL SUMMARY:

This Prior Authorization Nurse conducts prospective review of authorization requests including selected specialties, medical treatments and services, elective hospital admissions, ancillary services, home care and out of area referrals. The nurse makes clinical decisions based on established criteria and regulatory requirements. Prepares documentation and presents prior authorization requests to the Medical Director for additional review. This position works closely with the NOA coordinator to develop/review denial letters.

QUALIFICATIONS

? RN/LPN with current License in state of FL

? Minimum of three (3) years of experience with hospital/provider office nursing

? Previous experience on insurance side (not provider side)

? Previous Prior Authorization experience preferred

? Excellent verbal and written communication skills

? Excellent organizational skills

? Knowledge of AHCCCS and Medicare regulations

? Knowledge of Milliman guidelines

? Knowledge of CRS

? Computer literate (proficient in MS Office, Excel, Word)

? Team player with excellent attitude

? Strong service orientation and professionalism



ESSENTIAL DUTIES AND RESPONSIBILITIES:

? Perform prior authorization process by performing clinical review of requests requiring medical review and entering authorizations into the system.

? Provides clear and accurate documentation on rational for approving request or reason for sending to the Medical Director for additional review.

? Handle telephone requests timely and accurately.

? Develop and update health plan resources and forms to assist staff in their day to day functions. Provide resources and training to prior authorization technicians upon completion.

? Assist Case Management and Concurrent Review staff with complex cases.

? Assist with the design and updating of PA grids and desktop processes.

? Assist in reviewing and making revisions to department policies to assure compliance with regulatory agencies.

? Participate in interdepartmental projects as needed.

We are an equal employment opportunity employer and will consider all qualified candidates without regard to disability or protected veteran status. More...

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