drjobs Prior Authorization RN

Prior Authorization RN

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1 Vacancy
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Job Location drjobs

Denver, CO - USA

Yearly Salary drjobs

$ 80000 - 85000

Vacancy

1 Vacancy

Job Description

Prior Authorization RN:
This is a professional position that uses clinical judgment and critical thinking as part of a comprehensive program to assist the CHP Care Management team and clients in their efforts to provide appropriate and efficient quality care to their patients. The Prior Authorization Nurse/Care Manager is responsible for clinical review of requests for health care services.
  • Clearly and accurately documents relevant information.
  • Displays professional communication with clients and coworkers.
    • Utilizes clinical judgment to evaluate requests according to accepted guidelines taking into account specific state benefit plans and clinical conditions (age comorbidities complications progress of treatment etc.
  • Identifies potential case management issues and forwards to the appropriate team member.
  • Follows documented guidelines and processes for preauthorization requests within appropriate timelines for all lines of business.
  • Participates in monitoring of caseloads and allocation of staff resources to effectively manage workloads through collaboration with other team members.
  • Participates as a part of the CHP Prior Authorization team by actively interacting with other team members to distribute work fairly and resolve issues.
  • Uses customer service and communication skills to interact with providers schedulers and other client representatives.
  • Ensures accurate and timely processing of referrals according to regulatory and company policy.
  • Consistently meet quality and productivity goals as determined by volume and department needs.
Applicants must live in one of the following states to be considered: Colorado Oregon Ohio Illinois and Arkansas.
Qualifications (Education/Experience/Knowledge/Skills/Abilities):
Education: Graduate of accredited school of nursing with BSN; may be waived for individuals who have an RN licensure.
Experience: Three to five years clinical nursing experience. Prior correctional clinical experience preferred. Previous utilization management case management or discharge planning experience is preferred but not required.
Licenses/Certifications: Valid unrestricted Registered Nurse license for the state of practice.
Other Job Requirements: Able to perform basic to intermediate level of competence with various computer software applications including MS Outlook Word Excel Access and PowerPoint. Able to effectively communicate with internal staff clients and external customers. Full command of the English language both verbal and written. Home office that is HIPAA compliant for all remote or telecommuting positions as outlined by the company policies and procedures.
Must adhere to CHPs five core values:
  • Integrity:To do the right thing even when nobody is watching.
  • Teamwork:To collaborate and to support each other in achieving a common goal.
  • Accountability:To take responsibility for our successes and failures and to hold ourselves and others to high standards.
  • Patientcentered:To identify patient needs and provide optimal patient care.
  • Compassion:To be empathetic toward the needs of our clients patients and coworkers.
Correctional Health Partners offers a professional atmosphere competitive salaries and a full range of benefits. Benefits we provide include:
  • 401(k) plan.
  • Medical dental and vision benefits.
  • Flex spending medical and dependent care plans are available.
  • Paid time off up to 28 days per year based on tenure and position.
  • Paid holidays: we recognize 9 holidays.
  • Education tuition reimbursement.
Salary Range: $80000 to $85000.00 Annually dependent on experience
Correctional Health Partners is an Equal Opportunity Employer.All qualified applicants will receive consideration for employment without regard to race color religion sex age national origin protected veteran status disability status sexual orientation gender identity or expression marital status genetic information or any other characteristic protected by law.


Employment Type

Full Time

Company Industry

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