Registered Nurse Pre-Service Authorization

Essentia Health•Duluth, MN

2d•$70,595 - $105,893•Remote

About The Position

This Registered Nurse position is on Essentia Health’s infusion therapy team. The team manages oncology and nononcologic infusion therapy referrals, as well as PET scans and radiation oncology. The role involves submitting treatment and therapy plans to insurance for prior authorization and reviewing insurance policies to confirm that patients meet policy requirements before care is provided. The nurse conducts Managed Care Programs in conjunction with third-party administrators’ health care agreements. Working collaboratively with Access Coordinators, the nurse provides clinical expertise and leadership for managed care activities, including referrals and prior authorization and precertification processes, using and revising established policies and procedures. The role also performs complex care coordination and referral management, collaborates with customer service personnel to resolve insurance issues and support smooth operations, and works with internal and external clinical and business-services teams. The position supports health care initiatives and compliance efforts with the Supervisor of Contracting & Payor Relations and Health Plans Medical Directors.

Requirements

Current nursing licensure in the state(s) of employment.
BSN or ADN degree from an accredited school or college of nursing.

Responsibilities

Conduct Managed Care Programs in conjunction with third-party administrators’ health care agreements.
Provide clinical expertise and leadership to Access Coordinators for managed care activities, including referrals and prior authorization and precertification processes.
Use and revise Essentia Health’s established policies and procedures for managed care activities.
Perform complex care coordination and referral management.
Submit oncology and nononcologic infusion therapy, PET scan, and radiation oncology treatment and therapy plans to insurance for prior authorization.
Review insurance policies to determine whether patients meet policy requirements before care is provided.
Collaborate with customer service personnel to support efficient service for insurance issue resolution and smooth operations.
Collaborate with internal and external clinical areas and business services.
Support health care initiatives and compliance issues with the Supervisor of Contracting & Payor Relations and Health Plans Medical Directors.