Ambulatory Nurse Specialist

23 hours ago


Newton, Massachusetts, United States Atlantic Health System Full time
Job Title: Ambulatory Nurse Specialist

Atlantic Health System is seeking an experienced Ambulatory Nurse Specialist to join our team. As a key member of our Women's Health department, you will be responsible for coordinating and overseeing all obstetrical and gynecological authorizations with our CMA Prior Authorization Specialist.

Responsibilities:
  • Enter information on the PRA/SPECT Perinatal Risk Assessment & Single Point Entry Client Tracking system for the State of New Jersey.
  • Initiate and manage the prior authorization process for all obstetrical patients and gynecological patients.
  • Communicate effectively with internal departments and insurance companies to obtain necessary authorization.
  • Gather and organize patient medical records, treatment plans, and other relevant documentation required for authorization.
  • Ensure all documentation provided meets insurance company requirements and guidelines.
  • Collaborate with providers to obtain additional information or clarification as needed.
  • Schedule and facilitate peer-to-peer reviews between providers and insurance company medical directors.
  • Document all communication and actions taken throughout the authorization process accurately and thoroughly.
  • Monitor the progress of authorization requests and follow up as necessary to expedite approvals.
  • Stay updated on changes in insurance policies, guidelines, and procedures related to prior authorizations.
  • Provide support and guidance to providers and staff regarding prior authorization requirements and processes.
Qualifications:
  • Current NJ RN License
  • Current BLS
  • Women's Health Experience
  • Knowledge of prior authorizations and medical necessity
  • Strong understanding of medical terminology, procedures, and pharmaceuticals
  • Excellent communication skills, both verbal and written, with the ability to effectively interact with insurance companies, healthcare providers, and patients
  • Detail-oriented and organized, with the ability to manage multiple tasks and prioritize workload effectively
  • Proficient computer skills, including experience with electronic medical records Epic systems and Microsoft Office Suite
  • Ability to work independently and as part of a team in a fast-paced environment


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