PRIOR AUTHORIZATION NURSE

The Hospital Authority of Miller County•Colquitt, GA

1h•Onsite

About The Position

The purpose of the Prior Authorization nurse is to provide timely review of authorization requests and ensure the requests meet national standards and contractual requirements. The prior authorization nurse will promote the quality and cost effectiveness of patient care using clinical acumen. As a prior authorization nurse, you review requests for authorization for specific medications, treatments, or surgeries. Duties include reviewing medical records and documents related to the application. You consider each prior authorization request and collect evidence and patient information to support your decision. You communicate with the insurance provider to obtain additional information if needed. Your responsibilities in this position also involve ensuring the authorization meets regulations and requirements and contractual obligations of all parties involved. Your job can also require coordinating with administrators and healthcare providers to gain necessary information and ensure that patients receive authorized care. Additionally, the PA nurse will assist the clinical team with providing direct patient care services, designated independent procedures, and completing nursing tasks when needed. Provides care that meets the psychosocial, physical and general aspects of care; meets the communications needs of patient and family; provides care that reflects initiative and responsibility indicative of professional expectations, under the supervision of a registered nurse and/or physicians. Maintains regulatory requirements, nursing and office/clinic policies, procedures and standards. Communicates with physicians and team members about patient’s clinical condition, including results of diagnostic studies and symptomatology.

Requirements

Ability to communicate in English, both verbally and in writing.
Strong written and verbal skills.
Basic Computer Skills
Current LPN licensure in State of Georgia
Active American Heart Association BLS certification within 30 days of hire.

Nice To Haves

Additional languages preferred.
Experience in doing prior authorizations preferred.

Responsibilities

Provide timely review of authorization requests and ensure the requests meet national standards and contractual requirements.
Promote the quality and cost effectiveness of patient care using clinical acumen.
Review requests for authorization for specific medications, treatments, or surgeries.
Review medical records and documents related to the application.
Consider each prior authorization request and collect evidence and patient information to support your decision.
Communicate with the insurance provider to obtain additional information if needed.
Ensure the authorization meets regulations and requirements and contractual obligations of all parties involved.
Coordinate with administrators and healthcare providers to gain necessary information and ensure that patients receive authorized care.
Assist the clinical team with providing direct patient care services, designated independent procedures, and completing nursing tasks when needed.
Provide care that meets the psychosocial, physical and general aspects of care.
Meet the communications needs of patient and family.
Provide care that reflects initiative and responsibility indicative of professional expectations, under the supervision of a registered nurse and/or physicians.
Maintain regulatory requirements, nursing and office/clinic policies, procedures and standards.
Communicate with physicians and team members about patient’s clinical condition, including results of diagnostic studies and symptomatology.
Perform all job responsibilities in alignment with the mission and vision of the organization.
Perform other duties as required and complete all job functions as per departmental policies and procedures.
Maintain current knowledge in present areas of responsibility (i.e., self-education, attends ongoing educational programs).
Attend staff meetings and complete mandatory in-services and requirements and competency evaluations on time.
Wear protective clothing and equipment as appropriate.
Provide direct patient care under the supervision of a physician PA, or NP evaluates outcomes, consults with other health team members as required and adjusts nursing care process as indicated to ensure optimal patient care.
Perform a head-to-toe assessment, under the supervision of a physician, PA or NP on all patients as per policy. This includes neonate, pediatric, adolescent and geriatric patients and the general patient population.
Adequately assess and reassess pain.
Utilize appropriate pain management techniques.
Educate the patient and family regarding pain management.
Perform all aspects of patient care in an environment that optimizes patient safety and reduces the likelihood of medical/health care errors.
Perform patients care responsibilities considering needs specific to the standard of care for patient’s age.
Demonstrate knowledge of the principles if growth and development over the life span and the skills necessary to provide age-appropriate care to the patients served.
Interpret data about the patient’s status in order to identify each patient’s age specific needs and provide care needed by the patient group.
Maintain current knowledge of medications and their correct administration based on age of the patient and his/her clinical condition.
Carry out medical and surgical asepsis during treatments and special procedures.
Demonstrate the ability to assist physicians with procedures and perform services requiring technical and manual skills under the direction of a physician, PA and/or NP.
Demonstrate ability to revise plan of care as indicated by the patient’s response to treatment.
Demonstrate the ability to perform treatments and provide services to level of licensure.
Meet current documentation standards and policies.
Demonstrate knowledge of lab requirements, requisitions.
Follow Code of Conduct policy.
Adhere to dress code; appearance is neat and clean.
Complete annual educational requirements.
Maintain regulatory requirements.
Maintain patient confidentiality at all times.
Report to work on time and as scheduled; completes work within designated time.
Wear identification when on duty; uses computerized time clock system correctly.
Complete in-services and returns in a timely fashion.
Attend annual review and/or skills fair and department in-services, as scheduled.
Attempt to end conversations and other interactions in a positive manner; leaves others with a good impression of the Hospital Authority of Miller County and its employees.
Comply with all organizational policies regarding ethical business practices.
Communicate the mission statement of the organization.
Comply with federal, state and local laws and regulations, as well as, HAMC Policies and Procedures.
Participate in, comply with and report concerns to his or her supervisor or the Compliance Officer if illegal or unethical behavior is suspected.
Use user or role-based access to applicable ePHI systems based on your position, for minimum necessary access to perform your job function(s) only and should be used only as applicable.