Hill Physicians is seeking an Authorization Nurse (RN) for a hybrid role focused on evaluating medical necessity and appropriateness of services. The ideal candidate will have experience in Managed Care Utilization Management with strong analytical skills, and the position offers a competitive salary and a supportive workplace culture
Job Summary
The Authorization Nurse evaluates medical appropriateness using contracts, policies, and evidence-based clinical guidelines to ensure efficient care for members.
Hill Physicians is recognized as one of the 'Best Places to Work' and 'Healthiest Places to Work' in the Bay Area, offering a supportive DE&I environment.
The role requires processing urgent and non-urgent authorization requests while collaborating with physician reviewers and utilizing critical thinking to resolve complex cases.
Matching Summary
Match Score: 85
Hill Physicians is seeking an Authorization Nurse (RN) for a hybrid role focused on evaluating medical necessity and appropriateness of services. The ideal candidate will have experience in Managed Care Utilization Management with strong analytical skills, and the position offers a competitive salary and a supportive workplace culture.
Salary
Base: $100,000 - $123,000 Annual; Bonus/Equity: Not specified; Benefits: Not specified
Skills & Requirements
Must-have
Active California RN or LVN licensure
Managed Care Utilization Management experience
Medical decision support tools like MCG
Nice-to-have
Experience with Epic Tapestry platform
Strong critical thinking and problem-solving skills