RN Pre-Service Authorization

2 days ago

Duluth MN, United States Essentia Health Full time

RN Pre-Service Authorization at Essentia Health summary:

The RN Pre-Service Authorization role involves conducting Managed Care Programs in collaboration with third-party administrators, providing clinical expertise to Access Coordinators, and managing the referral and authorization processes. This position includes care coordination, working with various stakeholders to resolve insurance issues, and ensuring compliance with health care initiatives. A Bachelor's of Science in Nursing (BSN) or an Associate's Degree in Nursing (ADN) and current nursing licensure are required for this vital position.

Building Location: Business Service Center

Department: 48850 Prior Authorization

Job Description: Conducts Managed Care Programs in conjunction with third party administrators’ health care agreements. Works collaboratively with and provides clinical expertise and leadership to Access Coordinators to perform all aspects of managed care, including the referral, prior authorization/precertification processes, using and revising Essentia Health’s established policies and procedures for managed care activities. Performs complex care coordination and referral management. Works collaboratively with the Essentia Health customer service personnel to provide efficient service for insurance issue resolution and smooth operations. Works collaboratively with clinical areas and business services both internally and externally. Supports efforts and participates with the Supervisor of Contracting & Payor Relations and the Health Plans Medical Directors regarding health care initiatives and compliance issues for health plans.

Education Qualifications:

BSN or ADN degree from an accredited school or college of nursing

Be a part of a Healthcare organization that invests in you and your career .

Apply now and help us continue to raise the bar in patient care

Licensure/Certification Qualifications:

Current nursing licensure in state(s) of employment

Our Benefits are exceptional and Include:

  • Tuition Reimbursement/Assistance Program
  • Paid Personal Leave
  • 401k (with Essentia Health annual match)
  • Life and Disability Insurance options
  • Adoption Assistance
  • Employee wellness program
  • Medical & Dental insurance options

***

Like nowhere else:

To learn more about Duluth and our surrounding areas:

FTE: 0

Possible Remote/Hybrid Option:

Remote

Shift Rotation: Day Rotation (United States of America)

Shift Start Time: Day

Shift End Time: Day

Weekends:

Holidays: No

Call Obligation: No

Union: DC USWA Main & Neighborhoods (DCUMN)

Union Posting Deadline:

Keywords:

Registered Nurse, Managed Care, Prior Authorization, Care Coordination, Insurance Resolution, Clinical Expertise, Health Administration, Referral Management, Healthcare Compliance, Access Coordination

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