Remote Work Eligibility Base on Experience & Department Needs
The Authorization Specialist (RN) collaborates with all clinical service areas, physician clinics, and third-party payers to obtain prior authorizations or pre-certifications and resolve clinical appeals to ensure accurate and timely payment for services. This role requires an active Registered Nurse license due to the clinical expertise necessary to interpret medical documentation, determine medical necessity, and engage in clinical-level reviews and communications with providers and payers. Compliance with federal, state, and local laws, PMHC policies, and Medical Staff rules and regulations is a condition of employment.
