LPN / RN - SCC GENERAL SURGERY

South Central Regional Medical Center•Laurel, MS

6d•Onsite

About The Position

The LPN/RN is a critical member of the general surgery team, responsible for delivering patient care, managing authorization processes for advanced imaging, procedures, and surgeries, and performing peer-to-peer reviews with insurance companies to appeal and reverse denials. This role ensures seamless coordination between patients, providers, and external facilities while upholding high standards of nursing care.

Requirements

Graduate of an accredited nursing program.
Current unrestricted LPN or RN license in Mississippi.
BLS certification required.
Minimum of three years of clinical nursing experience.

Nice To Haves

Previous experience with prior authorizations, appeals, and peer-to-peer reviews strongly preferred.

Responsibilities

Obtain and submit prior authorizations for surgeries and advanced imaging studies including MRIs and CT scans.
Perform peer-to-peer reviews with insurance companies to appeal and reverse denials.
Maintain accurate documentation of authorization requests, approvals, and appeals in the EMR.
Perform patient assessments including vital signs and pain evaluations.
Educate patients regarding conditions, procedures, and recovery expectations.
Assist providers with wound care, suture removal, and other office procedures.
Serve as a liaison between patients, providers, insurance companies, and external facilities.
Maintain organized records of authorizations, appeals, and approvals for compliance and reporting purposes.
Adhere to clinic policies, infection control standards, and HIPAA regulations.
Maintain current certifications and participate in ongoing education.
Demonstrate strong organizational and time management skills.
Communicate effectively with patients, providers, and insurance representatives.
Advocate for patients during authorization and appeals processes.
Utilize EMR systems and prior authorization platforms effectively.
Maintain compliance with organizational policies and regulatory requirements.