Pre-Certification Nurse
University HealthCare Alliance - Richmond, CA

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Affinity Medical Solutions has an immediate opening for a Pre-certification Nurse. This position will be responsible for using evidenced based criteria sets and or Healthplan criteria to review provider requests for prior authorization of outpatient and inpatient services for commercial and Medicare product lines.

Desired Skills & Experience
    • Licensed RN or LPN with a strong working knowledge of clinical criteria sets such as CMS local and national guidelines, Milliman criteria, and Interqual criteria

    • Minimum 5 years in a medical setting, Healthplan or medical group setting preferred

    • Prior precertification experience required

    • Experience working with Healthplans, IPAs, physician offices, ancillary vendors and hospitals

    • Ability to read and interpret healhplan contracts/DOFRs, medical policy guidelines

    • Good typing/documentation and business grammar are a MUST

    • Strong communication skills (verbal & written) - excellent telephone communication ability is a MUST

    • Computer skills, including word processing, required.

    • Comfortable using/searching health-plan and government websites

To Apply We invite you to send your resume and cover letter to: . Please include "Pre-Certification Nurse" in the subject line.

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