RN Pre-Service Authorization

Essentia Health•Duluth, MN

22h•Remote

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

Current nursing licensure in state(s) of employment

Nice To Haves

BSN or ADN degree from an accredited school or college of nursing

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.