Essentia Health | RN Pre-Service Authorization
1 day ago
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 CenterDepartment:48850 Prior AuthorizationJob 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
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Like nowhere else:
learn more about Duluth and our surrounding areas: style="text-align:inherit">
FTE:0Possible Remote/Hybrid Option:
RemoteShift Rotation:Day Rotation (United States of America)Shift Start Time:DayShift End Time:DayWeekends:Holidays:NoCall Obligation:NoUnion: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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