Prior Authorization Nurse - LPN
About The Position
This position exists to promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to the request for prior authorization. Specific duties are determined by the work setting or patient population served; however, in all positions, serving patients with challenging and complex conditions requires a concentration of specialized staff able to work in highly coordinated teams. We organize care around each patient’s condition which requires staff at multiple levels and across many departments to exhibit exceptional teamwork qualities including communicating efficiently and effectively and adopting the behaviors required for high functioning integrated teams, consistent with our Gillette CARES expectations.
Requirements
- Licensure through the MN Board of Nursing is required along with a minimum of one year nursing experience in a healthcare environment.
- Minimum licensure as a Licensed Practical Nurse (LPN) from the MN Board of Nursing is required. Candidates/incumbents with a valid MN Registered Nursing (RN) License are qualified for this position as well.
- Documentation of completion of a practical nursing program (LPN program) If candidate holds a RN license instead of LPN license, documentation of RN education program is required.
- Knowledge of pharmacy, pharmaceuticals or healthcare business.
- Minimum one year of nursing experience in a healthcare environment
- Knowledge of Payer requirements and expectations regarding prior authorization
- Familiarity with CPT/HCPCS and ICD-10
- Ability to proficiently analyze and interpret clinical criteria
- Works effectively across organization and fosters teamwork
- Demonstrates the ability to utilize resources while building strong credible working relationships with clients, patients and internal partners
- Demonstrated excellent customer service and communication skills – verbal, written, and listening.
- Demonstrated knowledge of medical terminology
- Proficient technology skills, including working with a computer (PC) using Microsoft Office Products, databases and other programs.
- Must demonstrate ability to work independently with analytical, problem-solving and decision- making.
Nice To Haves
- Active professional affiliations and /or national certification related clinical specialty preferred
Responsibilities
- Perform the processing of authorizations, certifications and referrals needed from payers in order to allow reimbursement at the highest levels for both the patient and for the organization.
- Utilize available resources for checking patient insurance benefits and eligibility to determine prior authorization requirements, and to better inform our patients of their estimated financial liability.
- Must abide by all Joint Commission requirements including, but not limited to, sensitivity to cultural diversity, patient care, patients' rights and ethical treatment, safety and security of physical environments, emergency management, teamwork, respect for others, participation in ongoing education and training, communication and adherence to safety and quality programs, sustaining compliance with National Patient Safety Goals, and licensure and health screenings.
- This position is responsible for maintaining professional and ethical behavior at all times as outlined by licensing guidelines and company policies.
Benefits
- Gillette supports career progression and offers a competitive benefits package that includes a retirement savings match, tuition and certification reimbursement, paid time off, and health and wellness benefits for .5 FTE and above.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
