Peer to Peer Advanced Practice Provider
About The Position
The Advanced Practice Provider (Nurse Practitioner or Physician Assistant) provides comprehensive direct patient care management and manages a caseload through autonomous assessment, diagnosis, and initiation of delegated medical treatments. The APP provides healthcare and patient services that may include education, research, and clinical support, and completes administrative activities under the direction and supervision of the Director/leadership. The APP has the knowledge, skills, and judgment to assist physicians through organized instruction and supervised practice. The APP supports prior authorization, pre-certification, and financial clearance for planned elective procedures and services, including surgery, advanced imaging, and other services requiring clinical review. This includes conducting peer-to-peer reviews with insurance companies, providing clinical support for authorization requests, assisting with clinical appeals, and collaborating with ordering clinicians to resolve authorization barriers. The APP also educates clinicians about payer requirements, documentation expectations, and best practices to improve authorization outcomes, streamline workflows, and reduce preventable delays and denials of care. The role is approximately 80% virtual, focused on peer-to-peer insurance authorization reviews during daytime business hours, and 20% continued clinical practice within the APP’s selected specialty. This position offers an opportunity to help build and shape a new team.
Requirements
- Minimum of three years of Advanced Practice Provider experience; at least three years of APN experience for Nurse Practitioners or PA experience for Physician Assistants.
- Ability to exercise autonomy in medical decision-making and provide a broad range of diagnostic and therapeutic services.
- Strong communication with collaborating physicians to support decision-making.
- For Nurse Practitioners: Master’s of Science in Nursing.
- For Nurse Practitioners: Current or eligible for State of Illinois RN and APN licensure/registration.
- For Nurse Practitioners: Certification as a Nurse Practitioner by the ANCC or AANP.
- For Nurse Practitioners: Must have or be able to qualify for Illinois and DEA prescribing numbers.
- For Physician Assistants: Completion of an accredited physician assistant educational program.
- For Physician Assistants: ACLS certification and certification by the National Commission on the Certification of Physician Assistants (NCCPA).
- For Physician Assistants: Current or eligible for State of Illinois licensure/registration.
Responsibilities
- Manage a caseload and provide comprehensive direct patient care, including assessment, diagnosis, and initiation of delegated medical treatments.
- Support prior authorization, pre-certification, and financial clearance for planned elective procedures and services.
- Conduct peer-to-peer reviews with insurance companies.
- Provide clinical support for authorization requests and assist with clinical appeals.
- Collaborate with ordering clinicians to resolve authorization barriers.
- Educate clinicians on payer requirements, documentation expectations, and best practices for authorization.
- Provide healthcare and patient services that may include education, research, and clinical support.
- Complete administrative activities under the direction and supervision of the Director/leadership.
- Maintain clinical practice within the selected specialty.
- Communicate with collaborating physicians to obtain clinical support for decision-making.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
