Centralized Prior Authorization Nurse (RN or LPN)

Avera•Le Mars, IA

23h•Onsite

About The Position

Floyd Valley Healthcare is seeking a full-time Centralized Authorization Nurse (RN or LPN) to join their award-winning team in Le Mars, IA. This position is responsible for obtaining prior authorizations from insurers for medical tests, procedures, surgeries, and medications. The role involves documenting authorizations, communicating information to relevant parties, utilizing the electronic medical record, and assisting with appeals. Floyd Valley Healthcare emphasizes a positive culture that supports a healthy work-life balance.

Requirements

Current RN or LPN licensure in the state of Iowa.
Mandatory Reporter training certificate a plus; certification is required as an employee.
Pre-employment drug screen, background check, and employee health review including required immunizations are required.

Nice To Haves

Knowledge in ICD-10 and CPT is preferred but not required.
Previous prior authorization preferred but not required.

Responsibilities

Determine eligibility for all applicable payors by obtaining prior authorization from insurers for medical tests, procedures, surgeries and any other prior authorizations required by the patient’s insurance carrier or Local Coverage Determination (LCD) if needed.
Appropriately document prior authorization and communicate information to performing facility, physician, clinic staff and patient can/or patient’s family as necessary.
Obtain prior authorization approvals of medications by providing the appropriate documentation from patient charts to support the authorization request.
Utilization of electronic medical record to efficiently process required prior authorizations and communication with in the organization.
Communication with Nurse Manager status of denials and appeals.
Assist in the coordination of medical records retrieval to support appeal process.