RN Pre-Service Authorization
About The Position
Conducts Managed Care Programs in conjunction with third party administrators’ health care agreements. Works collaboratively with and provides clinical expertise and leadership to Access Coordinators to perform all aspects of managed care, including the referral, prior authorization/precertification processes, using and revising Essentia Health’s established policies and procedures for managed care activities. Performs complex care coordination and referral management. Works collaboratively with the Essentia Health customer service personnel to provide efficient service for insurance issue resolution and smooth operations. Works collaboratively with clinical areas and business services both internally and externally. Supports efforts and participates with the Supervisor of Contracting & Payor Relations and the Health Plans Medical Directors regarding health care initiatives and compliance issues for health plans.
Requirements
- BSN or ADN degree from an accredited school or college of nursing
- Current nursing licensure in state(s) of employment
Responsibilities
- Conducts Managed Care Programs in conjunction with third party administrators’ health care agreements.
- Works collaboratively with and provides clinical expertise and leadership to Access Coordinators to perform all aspects of managed care, including the referral, prior authorization/precertification processes, using and revising Essentia Health’s established policies and procedures for managed care activities.
- Performs complex care coordination and referral management.
- Works collaboratively with the Essentia Health customer service personnel to provide efficient service for insurance issue resolution and smooth operations.
- Works collaboratively with clinical areas and business services both internally and externally.
- Supports efforts and participates with the Supervisor of Contracting & Payor Relations and the Health Plans Medical Directors regarding health care initiatives and compliance issues for health plans.
Benefits
- medical, dental, vision, life, and disability insurance
- supplemental options
- 401(k) plan with employer contributions
- training, tuition reimbursement, and educational programs
- flexible scheduling
- generous time off
- wellness resources focused on your physical, mental, and emotional health
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
