PRIOR AUTHORIZATION NURSE

The Hospital Authority of Miller County•Colquitt, GA

12h

About The Position

The Prior Authorization Nurse provides timely review of authorization requests to ensure they meet national standards, contractual requirements, regulations, and the obligations of all parties. The nurse uses clinical judgment to support quality and cost-effective care by reviewing medical records and other documents, gathering evidence and patient information, and communicating with insurance providers to obtain additional information as needed. The role may also involve coordinating with administrators and healthcare providers to help ensure patients receive authorized care. The nurse also assists the clinical team with direct patient care, designated independent procedures, and nursing tasks as needed. Under the supervision of a registered nurse, physician, PA, or NP, the nurse provides care addressing patients’ psychosocial, physical, and general needs, communicates with patients and families, and demonstrates professional initiative and responsibility. The role requires maintaining applicable regulatory requirements and nursing and office/clinic policies, procedures, and standards, and communicating patients’ clinical conditions—including diagnostic results and symptoms—to physicians and team members.

Requirements

Current LPN licensure in the State of Georgia.
Active American Heart Association BLS certification within 30 days of hire.

Nice To Haves

Experience performing prior authorizations.

Responsibilities

Review authorization requests promptly and ensure they meet national standards and contractual requirements.
Provide direct patient care under the supervision of a physician, PA, or NP; evaluate outcomes, consult with other health team members as needed, and adjust nursing care as indicated.
Perform head-to-toe assessments, under appropriate supervision, for neonate, pediatric, adolescent, geriatric, and general patient populations according to policy.
Assess and reassess pain, use appropriate pain-management techniques, and educate patients and families about pain management.
Provide care in a manner that promotes patient safety and reduces the likelihood of medical or healthcare errors.
Consider age-specific standards of care and apply knowledge of growth and development across the lifespan to identify and meet patient needs.
Maintain knowledge of medications and their correct administration based on patient age and clinical condition.
Use medical and surgical asepsis during treatments and special procedures.
Assist physicians with procedures and perform services requiring technical and manual skills under the direction of a physician, PA, or NP.
Revise the plan of care as indicated by the patient’s response to treatment.
Perform treatments and provide services within the level of licensure.
Meet documentation standards and policies.
Demonstrate knowledge of laboratory requirements and requisitions.
Review medical records and related documents, collect evidence and patient information, and communicate with insurance providers to obtain information needed for authorization decisions.
Coordinate with administrators and healthcare providers to obtain necessary information and help ensure patients receive authorized care.
Maintain regulatory requirements and nursing and office/clinic policies, procedures, and standards.
Communicate patients’ clinical conditions, including diagnostic study results and symptoms, to physicians and team members.