Registered Nurse Authorization Review Job Staffing Solutions Organization LLC Augusta

We are excited to announce the availability of new job opening at Staffing Solutions Organization LLC that constantly seeking talented and motivated individuals to join the team. Below, you will get information on the current job openings, including job descriptions, requirements, and application instructions.

Staffing Solutions Organization LLC Recruitment

Registered Nurse Authorization Review Jobs in Augusta

Description :

Staffing Solutions Organization LLC (SSO), an affiliate of Public Consulting Group LLC (PCG), is focused on delighting clients with world-class managed staffing and talent consulting services. SSO is committed to a diverse workforce, which is a reflection of our clients and the people they serve.

Registered Nurse - Authorization Review Unit – MaineCare in Augusta, ME

This position is a hybrid and requires two days a week onsite in Augusta.

Position Duties:

• Manage medical Prior Authorizations (PA) as assigned by the PA supervisor, utilizing PA software tools.
• Review and authorize provider requests for the following services in the MaineCare Benefits Manual (MBM): Section 97, Private Duty Nursing and Personal Care Services, Sec. 85, Physical Therapy, Sec. 68, Occupational Therapy, Sec. 109, Speech Therapy, Sec. 1.14-2 Out-of-State Services, Sec. 94, Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services, and other services, assigned.
• Perform day-to-day activities required for PA processing and follow defined business rules and policies, including timeliness requirements.
• Resolve escalated complex PA reviews/dispositions based on business rules and workflow policies.
• Work with the Prior Authorization unit staff members to monitor work queues and complete assigned tasks.
• Conduct regular quality assurance reviews of decided PAs.
• Collaborate with other OMS units to resolve claims issues that involve PAs.
• Respond to questions and concerns from interested parties regarding PA criteria and processes.
• Be responsible for communications to providers, MaineCare members, and others via phone, fax, and mail.
• Perform basic research on medical conditions, medical services, and health care providers. and
• Perform other duties and responsibilities as may be assigned.

Knowledge and Certification Requirements:

• Knowledge of the principles and methods of professional nursing practice.
• Knowledge of current standards of care and practices relating to services provided by health care facilities, agencies, and practitioners.
• Ability to plan, organize, and direct the work of others.
• Ability to maintain objectivity and professionalism during unusual and stressful circumstances.
• Ability to communicate effectively
• Ability to write clearly and effectively

These may be acquired on the job and are needed to perform the work assigned:

• Knowledge of state and federal regulations relative to the qualifications of health care professionals and paraprofessionals.
• Knowledge of community organizations and resources.
• Knowledge of state licensing and federal certification regulations for health care providers.
• Knowledge of federal and state accreditation commissions and standards.
• Knowledge of Department policies and procedures.
• Knowledge of the Maine Medical Assistance Manual.
• Ability to interpret and apply federal and state rules and regulations.
• Ability to provide technical assistance.
• Ability to develop and implement corrective actions.

Minimum Qualifications:

• Registered Nurse and three (3) years of progressively responsible experience in the field of nursing and/or in the delivery of health care services.

Licensing Requirements:

• Licensed as a Registered Professional Nurse or Licensed Practical Nurse (LPN) in the State of Maine as issued by the State Board of Nursing. RN is preferred. However, an LPN is acceptable if an RN is not available.

Compensation for roles at Staffing Solutions Organization LLC (SSO) varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience. As required by applicable law, SSO provides a reasonable range of compensation for this role. In addition, SSO provides a range of benefits for this role.

Applicants must be authorized to work for ANY employer in the U.S. We are unable to sponsor or take over sponsorship of an Employment Visa at this time.

All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, marital status, age, national origin, protected veteran status, or disability. Staffing Solutions Organization LLC is an e-Verify participant.

For more detail information about the program, please refer official source from Staffing Solutions Organization LLC on following link below. If you meet these requirements, please register yourself at :

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