Registered Nurse II - Prior Authorization and Referral

Texas A&M University System • College Station, TX

5d • Onsite

About The Position

University Health Services empowers Texas A&M students through integrated care that supports their physical and mental health. As part of Texas A&M Health—the university’s comprehensive health science center—our clinicians provide the highest level of care in medicine, counseling, psychology and emergency medical services that fosters students’ academic, personal and professional success.
The Registered Nurse II- Prior Authorization and Referral, manages the end-to-end administration of prior authorizations and external specialty referrals to ensure patients receive timely, continuous care. This role involves navigating complex payer policies, gathering clinical documentation, managing coverage denials through peer-to-peer reviews, and connecting patients with financial assistance programs. Additionally, the position supports daily clinic operations, educates patients on their coverage and care plans, and serves as a key resource for staff to drive ongoing workflows and quality improvements.

Requirements

• Associate Degree in Nursing.
• Two years of experience as a Registered Nurse.
• Must be licensed by the State of Texas as a Registered Nurse.
• CPR certified.
• Knowledge of standard nursing procedures and techniques.
• Strong understanding of insurance guidelines and prior authorization processes.
• Ability to review and interpret clinical documentation to determine what is required for prior authorizations and referrals.
• High level of comfort with computers, databases, and web-based systems; able to independently navigate payer portals, referral platforms, and electronic records systems.
• Excellent organizational, communication, and problem-solving skills.
• Ability to multitask and work cooperatively with others.
• Ability to handle sensitive information and maintain confidentiality.
• Proficiency in documenting and navigating electronic medical records.

Nice To Haves

• Bachelor's degree in Nursing.
• Two years of experience as a Registered Nurse, within the last ten years, including experience in at least one of the following areas: Prior authorizations or utilization management, Care coordination or case management, Insurance or payer policy navigation, Outpatient clinic operations or referral processing, Reviewing medical documentation for insurance or compliance purposes, Working in a college health, primary care, or ambulatory care setting.
• Experience spanning multiple areas listed above (e.g., combining prior authorizations with outside medication management, clinic operations, or care coordination).
• Experience with direct supervision of employees, performance evaluations, staffing, and/or scheduling.

Responsibilities

• Reviews and processes prior authorizations for medications, radiology procedures, and specialty services.
• Navigates payer policies including step therapy protocols, quantity limits, preferred drug lists, and therapeutic substitutions.
• Assists patients and providers in identifying and applying for patient assistance programs or financial assistance when available.
• Facilitate peer-to-peer reviews with payers when pre-authorizations are denied.
• Collaborate with providers to gather necessary clinical documentation and address denials or escalations.
• Tracks status of authorizations and manages related communications with patients and staff.
• Coordinates external referrals to specialty providers, ensuring completeness of documentation and timely submission.
• Follow up with external offices, providers, and students to support continuity of care.
• Maintains accurate tracking and communication regarding referral outcomes.
• Supervises designated nursing or medical support staff by managing workload distribution, scheduling, and coverage planning.
• Reviews and approves time sheets, time off requests, and ensures coverage meets operational needs.
• Provides coaching and timely feedback to support employee development and professional growth.
• Participates in performance evaluations alongside the nursing leadership.
• Educates patients on referral processes, coverage details, and treatment plans.
• Documents clinical and administrative activities in the electronic medical record.
• Supports day-to-day operations in the clinic, assists in scheduling and patient flow.
• Helps ensure compliance with healthcare regulations and university policies.
• Assists with the implementation of clinic policies, standards, and procedural updates.
• Serves as a resource for nursing and administrative staff on prior authorization and referral policies.
• Participates in the development and implementation of workflow improvements related to access and coordination of care.
• Participates in onboarding and training of new staff, ensuring orientation to clinic protocols and standards.
• Represents the nursing team in interdisciplinary meetings or process improvement groups, as needed.

Benefits

• Medical, prescription drug, dental, vision, life and AD&D, flexible spending accounts, and long-term disability insurance with Texas A&M contributing to employee health and basic life premiums
• 12-15 days of annual paid holidays
• Up to eight hours of paid sick leave and at least eight hours of paid vacation each month
• Automatic enrollment in the Teacher Retirement System of Texas
• Health and Wellness: Free exercise programs and release time
• Professional Development: All employees have access to free LinkedIn Learning training, webinars, and limited financial support to attend conferences, workshops, and more
• Educational release time and tuition assistance for completing a degree while a Texas A&M employee
• Living Well, a program at Texas A&M that has been built by employees, for employees

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree