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A Just-In-Time “PRN” Model Of Licensed Health Plan Nurses With Senior Level Clinical Review Capabilities Utilizing The Major Software Systems

posted by Blue Eagle

on February 22, 2021

The Problem

Health Plans are constantly looking for nurses who understand the Health Plan Business and who have done clinical Reviews of both Prior Authorization and Inpatient Confinement cases. Most nurses are only experienced with working in a Provider setting (i.e. hospitals, clinics, and physician offices). Therefore, Health Plans are dependent on attracting and hiring nurses with an appropriate state license but without Health Plan and/or PA Review experience – thus burdening the Health Plan UM Department(s).

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