Authorization Nurse, RN - 26-66

The Authorization Nurse evaluates the medical appropriateness and necessity of services using contracts, policies, and evidence-based guidelines while ensuring benefit eligibility requirements are met. This role collaborates with physician reviewers to determine authorization decisions for urgent, routine, and retrospective requests, ensuring efficient and timely care for members. Responsibilities include utilizing decision support tools like MCG, documenting cases in Epic Tapestry, and presenting arguments to medical directors for clinical decisions.