Precertification & Pre-Service Appeals Nurse

Precertification & Pre-Service Appeals Nurse

CURE Auto Insurance is a leading direct writer of auto insurance in New Jersey, Pennsylvania, and Michigan. CURE offers a great working environment, competitive salary, and a comprehensive benefits package which includes health and dental coverage, life and disability insurance, 401k with a generous company match, and much more! CURE is seeking a skilled and motivated Precertification & Pre-Service Appeals Nurse to join our team.

Essential Job Functions

• Prior Authorization Management: Review treatment plans to determine insurance authorization.
• Clinical Review: Analyze patient charts, physician notes, and diagnostic results to determine if treatment is appropriate as requested or to escalate to a physician for a review through physician review, peer review, or an Independent Medical Exam.
• Pre-Service Appeals: In the event of a pre-service dispute, investigate the root cause, compile necessary clinical arguments, and process formal pre-service appeal responses.
• Collaboration: Partner closely with physicians, advanced practice providers, and staff to obtain additional charting documentation or facilitate peer-to-peer reviews. Works closely with PIP representatives on case management.
• Compliance: Accurately and timely review and document all authorization statuses, reference numbers, and appeal outcomes
• Other related tasks as assigned

Experience/Qualifications

• Education: Graduate of an accredited School of Nursing (Associate or Bachelor’s degree).
• Licensure: Active, unrestricted Registered Nurse (RN) or Licensed Practical Nurse (LPN/LVN) license in the state of New Jersey.
• Experience: * Minimum of [2-3] years of clinical nursing experience
  Minimum of [1-2] years of experience in Precertification, Case Management, or Managed Care.
• Detail-oriented with strong written and verbal communication skills.
• Must be organized and have the ability to multitask while prioritizing work.

Benefits

• Comprehensive health benefits, including medical, dental, and vision coverage
• Generous paid time off (PTO days, sick days, and holidays)
• Flexible spending options with FSA & HSA plans
• Life and AD&D insurance
• 401(k) with company match
• Voluntary benefits such as legal services, pet insurance, and identity & fraud protection
• 24/7 Employee Assistance Program (EAP) for employees and their families
• Health & wellness perks, including gym discounts, wellness reimbursements, and reward programs
• Fun, engaging in-office events that support our culture

Physical Actions/Environment

• Required job duties consist of prompt and regular attendance, ability to frequently move about the office to coordinate work with others; standing, sitting and typing for extended periods; and lifting and/or carrying up to 5 lbs.
• Able to frequently communicate with others in-person, on the phone/virtually, and in writing.
• Able to read, understand, process and evaluate large amounts of technical information and make related, informed decisions.

Starting Salary

$65,000-75,000 annually based on experience

Schedule

We offer flexible work hours between 8:00 AM and 5:00 PM, with options like 8–4, 8:30–4:30, or 9–5. We do our best to support individual preferences, though schedules may be adjusted as needed to ensure strong coverage and teamwork. We also offer a hybrid schedule: team members work onsite four days a week and can work remotely one day a week.

Location

Princeton, NJ