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Prior Authorization Nurse

2 months ago

Texarkana, United States Genesis Prime Care Full time
Job DescriptionJob Description

Job Summary

The purpose of the prior authorization nurse is to provide timely review of authorization requests and ensure the requests meet national standards and contractual requirements. The prior authorization nurse will also promote the quality and cost effectiveness of patient care using clinical acumen. Additionally, the nurse will prepare documentation, perform audits of patient records, and assist management as needed.

Knowledge, Skills and Abilities

Required

  • Knowledge of basic principles of health promotion, prevention and motivation
  • Knowledge of protocols in general and an ability to quickly gain specific knowledge of the Clinic’s current operational protocols
  • Knowledge of medical terminology and appropriate abbreviations
  • Demonstrates knowledge of the Texas Nursing Practice Act
  • Ability to read and comprehend medical instructions, short correspondence, and memos
  • Ability to document, with clarity, all information relevant to a patient’s needs
  • Ability to effectively present information in small group situations to patients, Clinic staff, and the general public. Ability to prepare statistical and administrative reports
  • Ability to work cooperatively with community agency personnel to coordinate services for patients
  • Ability to use a glucometer and interpret the results
  • Ability to use office equipment including but not limited to computers, fax machines, telephones and copiers
  • Ability to prioritize and allocate resources

Preferred

  • Spanish speaking and writing skills

Credentials and Experience

Required

  • Licensed Vocational Nurse degree from an accredited school of nursing.
  • Current unrestricted license from the state of Texas Board of Nursing
  • Current Cardiopulmonary Resuscitation (CPR) for Healthcare Professionals
  • Knowledge of utilization management and case management principles preferred
  • Prior authorization experience preferred
  • Advanced verbal, written communication, and organization skills
  • Knowledge of Microsoft word
  • Strong service orientation and professionalism

Preferred

  • One (1) year of practice experience as an LVN giving direct patient care