Prior Authorization Temp Nurse Case Manager

Review specialty referral requests to promote quality and cost-effective care by applying clinical acumen and policies to determine appropriate settings. Communicate daily with providers and staff regarding authorization issues, research alternative care plans, and route members to the most appropriate services. Perform case reviews based on screening indicators and evidence-based guidelines, document all authorization notes accurately, and maintain regulatory turnaround time standards. Act as a liaison between case managers, contracted providers, and members while coordinating ancillary professional services and DME approvals. Participate in service recovery efforts and report network needs for potential contracting opportunities. Requires current California RN license, one year acute care experience, and knowledge of CMS and health plan requirements.