US Registered Nurses | Clinical Authorization and Solutions Specialist  

The Clinical Authorization and Solutions Specialist is responsible for the initial assessment, prioritization, and coordination of patient care for patients based in the United States. This role involves collecting patient information, evaluating their medical condition, and determining the appropriate care pathway. The Intake Nurse acts as the first point of contact for patients and plays a crucial role in ensuring they receive timely and appropriate medical attention.

Responsibilities:

• Patient Assessment and Prioritization: Review and process prior authorization requests for medical procedures and medications, ensuring compliance with insurance guidelines and policies.
• Documentation: Accurately document and maintain patient records, authorization decisions, and relevant communications.
• Client Interaction: Conduct regular client presentations to explain authorization decisions and processes, ensuring transparency and client satisfaction.
• Solution Selling: Collaborate with the sales team to provide healthcare solutions tailored to client needs, contributing to business growth and client retention.
• Compliance: Ensure all activities comply with healthcare regulations, insurance requirements, and client-specific requirements.
• Communication: Liaise with healthcare providers, insurance companies, and clients to facilitate smooth authorization processes and resolve any issues.
• Training & Development: Stay updated on industry trends, policies, and best practices, and participate in ongoing training sessions

• Requirements
  • Valid US Registerned Nurse license is highly preferred. If not, please provide relevant certifications in healthcare management or clinical authorization.
  • Minimum of 3 years of experience in a similar role, preferably with prior authorization experience.
  • Strong knowledge of medical terminology, procedures, and insurance policies.
  • Excellent communication and presentation skills.
  • Proven ability to work independently and manage multiple tasks effectively.
  • Strong analytical and problem-solving skills.
  • Proficiency in using healthcare management software and MS Office applications.