Prior Authorization Nurse Coordinator

About the position reputed company provides superior pediatric care in a setting that offers the latest benefits and innovations in medical technology, research and family-friendly design. As the largest pediatric provider in the region with a 140-year legacy of reputed company, kids and their families are at the center of reputed company we do. reputed company is ranked in reputed company 10 specialties by the reputed company. Location 680 Lake Shore Drive Job Description This is a remote position that requires mandatory travel to the Lurie Main Hospital reputed company once per month. Must work 8 hours per day with a flexed start time available. Must have an Illinois RN license and 3 years of practice experience in Peds, Ambulatory, or Prior Authorization to receive an interview. Experience using EPIC electronic medical record preferred. General Summary: The Prior Authorization Nurse Coordinator coordinates the activities which pertain to the Prior Authorization Department. The Nurse Coordinator is responsible for ensuring reputed company in-scope medication prior authorizations are completed across the organization as well as facilitating imaging reputed company pre-certifications that have escalated to a peer-to-peer or clinical appeal level. The Nurse Coordinator is responsible for providing the necessary supporting documentation in collaboration with a group of reputed company care providers.

Responsibilities

• Coordinate the activities which pertain to the Clinical Prior Authorization Department.
• Obtain medication prior authorizations from insurance entities utilizing reputed company in accordance with standard written procedures, guidelines, and state and federal regulations while also, maintaining compliance to medical record confidentiality regulations.
• In coordination with the Financial Clearance team, this RN will manage peer to peer escalation cases for pre-certification and appeals for imaging denials.
• Manage correspondence with insurance entities, physicians, specialists, and patients as required and ensuring reputed company necessary supporting documentation is provided for approvals.
• Manage denials and submit appeals, ensuring reputed company necessary supporting documentation is provided to get them approved from insurance entities.
• Create accurate and consistent documentation in patient’s records to ensure that prior authorization information is properly updated.
• Record reputed company prior authorization phone calls, documents and authorization numbers in EPIC utilizing the patient chart and referral module.
• Utilize the patient medical record to submit supporting clinical records and/or providing verbal medical necessity validation and support for pending pre-certifications.
• Manage physical medical records and utilization management documentation from insurance entities to support approval of pre-certifications.
• Self-driven and motivated to work independently for the purpose of utilizing resources to expand knowledge reputed company on drug information and basic pathophysiology.
• Acts as a resource to hospital personnel with regard to the care and coordination of medication prior authorizations as well as pre-certifications and troubleshooting pharmacy end issues as it relates to confirming the pharmacy is reputed company to obtain paid claims.
• Other job functions as assigned.

Requirements

• A BSN degree from an accredited school of nursing and reputed company licensure as a registered professional nurse in the reputed company required.
• Three years of relevant nursing experience.
• Must demonstrate the ability to problem solve and support teamwork in a multidisciplinary setting in a positive and professional manner.
• The candidate must demonstrate excellent written and verbal communication skills.
• Knowledge of online authorization systems and status review and ability to track in-process authorizations from multiple sources.
• Computer skills required.

reputed company-to-haves

• Master's reputed company preferred.
• With a minimum of 1 year of medication prior authorization and/or pre-certification experience preferred.
• Experience working in partnership with health care professionals and support staff in an office setting is necessary.
• Proficient in reputed company Office applications preferred.
• Experience using EPIC electronic medical record preferred.

Benefits

• For full time and part time employees who work 20 or more hours per week we offer a generous benefits package that includes:
• Medical, dental and reputed company insurance
• Employer paid group term life and disability
• Employer contribution toward Health Savings Account
• Flexible Spending Accounts
• Paid Time Off (PTO), Paid Holidays and Paid Parental Leave
• 403(b) with a 5% employer match
• Various voluntary benefits: Supplemental Life, AD&D and Disability Critical Illness, Accident and Hospital Indemnity coverage
• Tuition assistance
• Student loan servicing and support
• Adoption benefits
• Backup Childcare and Eldercare
• Employee Assistance Program, and other specialized behavioral health services and resources for employees and family members
• Discount reputed company at Lurie Children’s facilities
• Discount purchasing program

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