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Job Summary

The Prior Authorization Nurse serves as the key interface between members, healthcare providers, and the HMO teams.

The role is responsible for accurate processing of member availments, issuance of Letters of Authorization (LOAs), timely call handling, and efficient coordination of inquiries and cases to ensure high-quality service delivery.

Responsibilities

1. Accurate and Efficient Adjudication of Member Availments and Issuance of LOA’s

• Review and process member availments and claims in accordance with company policies, HMO guidelines, medical indication, an...