Our Client, a Retail Pharmacy company, is looking for a RN - Outpatient Prior Authorization for their Remote location.
Responsibilities:
• Review outpatient prior authorization requests and apply appropriate medical necessity criteria (local/state guidelines, Medicare NCD/LCD, MCG where applicable).
• Gather and interpret clinical information and document accurate review outcomes.
• Ensure compliant, timely determinations aligned with state/federal requirements.
• Participate in MedCompass implementation activities: user testing, workflow validation, defect identification, and process refinement.
• Communicate determination outcomes professionally to providers and internal partners.
• Maintain high accuracy, reliability, and auditready documentation standards.
Requirements:
• Active and unrestricted RN license (Compact).
• Minimum 3 years clinical experience (acute care, ED, ICU, Telemetry, Med/Surg, Home Health, etc.).
• Prior authorization or utilization management experience.
• Experience with MCG, InterQual, QNXT, or similar systems.
• Experience in system transitions or healthcare technology implementations.
• BSN preferred.
• High accuracy and quality in clinical decision making and documentation.
• Proficiency with criteria application (NCD/LCD, Medicaid policy, MCG).
• Adaptability during system change and workflow stabilization.
• Associates Degree in Nursing
• Active Compact RN License
Why Should You Apply?
• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities
As an equal opportunity employer, ICONMA provides an employment environment that supports and encourages the abilities of all persons without regard to race, color, religion, gender, sexual orientation, gender identity or express, ethnicity, national origin, age, disability status, political affiliation, genetics, marital status, protected veteran status, or any other characteristic protected by federal, state, or local laws.