Prior Authorization Review Nurse at Tacoma

Job Description

Prior Authorization Review Nurse
Tacoma, WA; Burlington, WA; Portland, OR; Lewiston, ID; or Salt Lake City, UT
Telework available for those residing in Oregon, Washington, Idaho or Utah

Bring your clinical background and your attention to detail to this role where you will be responsible for providing prior authorization review of admission, stay, or other service or course of treatment to best meet the members specific healthcare needs and to promote quality and cost-effective outcomes. This can include review of outpatient procedures and services, and prospective prescription drug utilization review.

Minimum Qualifications:

• Active, unrestricted Registered Nurse (RN) licensure, and at least 3 years (or full time equivalent) of direct clinical care
  
• Knowledge of health insurance industry trends, technology and contractual arrangements.
  
• General computer skills (including use of Microsoft Office, Outlook, internet search). Familiarity with health care documentation systems.
  
• Strong verbal, written and interpersonal communication and customer service skills.
  
• Ability to interpret policies and procedures and communicate complex topics effectively.
  
• Strong organizational and time management skills with the ability to manage workload independently.
  
• Ability to think critically and make decisions within individual role and responsibility.
  
• Normally to be proficient in the competencies listed above the individual would have an Associate or Bachelors Degree in Nursing or related field and 3 years of case management, utilization management, disease management, auditing or retrospective review experience or equivalent combination of education and experience.

Job Requirements

Regence employees are part of the larger Cambia family of companies, which seeks to drive innovative health solutions. We offer a competitive salary and a generous benefits package. We are an equal opportunity employer dedicated to workforce diversity and a drug and tobacco-free workplace. A drug screen and background check is required.

Regence is 2.2 million members, here for our families, co-workers and neighbors, helping each other be and stay healthy and provide support in time of need. Weve been here for members more than 90 years. Regence is a nonprofit health care company offering individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management. We are the largest health insurer in the Northwest/Intermountain Region, serving members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington). Each plan is an independent licensee of the Blue Cross and Blue Shield Association.

If youre seeking a career that affects change in the health care system, consider joining our team at Cambia Health Solutions. We advocate for transforming the health care system by making health care more affordable and accessible, increasing consumers engagement in their health care decisions, and offering a diverse range of products and services that promote the health and well-being of our members. Cambias portfolio of companies spans health care information technology and software development; retail health care; health insurance plans that carry the Blue Cross and Blue Shield brands; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access and free-standing health and wellness solutions.


Country: USA, State: Washington, City: Tacoma, Company: Cambia Health Solutions.