Centralized Prior Authorization Nurse (RN or LPN)

Floyd-Valley-Healthcare; Le Mars (IA); On-site; USD 60,000 - 85,000; Full time

Benefits offered by this job

Student Debt Program

IPERS Retirement

Medical, Dental, and Vision insurance

Flexible Spending Account

Short-term and Long-term Disability

Life Insurance

Fitness Center

Paid Time Off

Job summary

Floyd Valley Healthcare in Le Mars, Iowa seeks a Centralized Authorization Nurse (RN or LPN) for a full-time role. You will determine payor eligibility, obtain prior authorizations for tests and medications, and document outcomes for the care team.

The position emphasizes efficient EMR use and clear communication with physicians, staff, and patients. Ideal candidates hold Iowa RN or LPN licensure and have knowledge of ICD-10/CPT; prior authorization experience is a plus.

Qualifications

• Current Iowa RN or LPN licensure is required.
• Knowledge of ICD-10 and CPT is preferred but not required.
• Prior authorization experience is preferred but not required.

Responsibilities

• Determine eligibility for payors by obtaining prior authorizations for tests, procedures, surgeries and LCDs when needed.
• Document prior authorizations and communicate results to the facility, physicians, clinic staff and patients.
• Obtain authorization approvals for medications by providing documentation from patient charts.
• Utilize the EMR to process required prior authorizations and communicate within the organization.
• Communicate status of denials and appeals with Nurse Manager; assist in records retrieval for appeals.

Skills

ICD-10 knowledge

Prior authorization process

Education

Iowa RN or LPN licensure

Job description

Location:Le Mars, IAWorker Type:RegularWork Shift:Day Shift (United States of America)Floyd Valley Healthcare is proud to offer a positive and fulfilling work environment that supports a healthy work-life balance. We understand that our employees have choices, and we strive to be an employer of choice for our team.Position HighlightsCome join our award-winning team at Floyd Valley Healthcare as a Centralized Prior Authorization Department Nurse (RN or LPN).Floyd Valley Healthcare in Le Mars, IA has a full-time Centralized Authorization Nurse (RN or LPN) position (40 hours per week).Floyd Valley offers a positive culture that supports a healthy work-life balance. Our Mission is to be a progressive healthcare partner serving with compassion, integrity and excellence.Responsibilities:Determine eligibility for all applicable payors by obtaining prior authorization from insurers for medical tests, procedures, surgeries and any other prior authorizations required by the patient’s insurance carrier or Local Coverage Determination (LCD) if needed.Appropriately document prior authorization and communicate information to performing facility, physician, clinic staff and patient can/or patient’s family as necessary.Obtain prior authorization approvals of medications by providing the appropriate documentation from patient charts to support the authorization request.Utilization of electronic medical record to efficiently process required prior authorizations and communication with in the organization.Communication with Nurse Manager status of denials and appeals. Assist in the coordination of medical records retrieval to support appeal process.Hours are Monday-Friday, 8:00am-4:30pm.Requirements:Current RN or LPN licensure in the state of Iowa.Knowledge in ICD-10 and CPT is preferred but not required.Previous prior authorization preferred but not required.Mandatory Reporter training certificate a plus; certification is required as an employee.We are proud to offer:Student Debt ProgramIPERS RetirementMedical, Dental, and Vision insuranceFlexible Spending Account (FSA)Short-term and Long-term Disability InsuranceLife InsuranceFitness CenterPaid Time OffCompetitive pay based on experienceAbout Floyd Valley Healthcare:Floyd Valley Healthcare is a 25-bed critical access hospital and is located in Le Mars, Iowa, home of "The Ice Cream Capital of the World!" Floyd Valley Healthcare has had a rich history of serving the healthcare needs of people in Le Mars, Iowa and the surrounding communities. Today, Floyd Valley includes the hospital, family medicine clinics in Le Mars, Marcus and Remsen, and public health. We serve people in their homes through home health and home medical services. Floyd Valley Healthcare is licensed by the State of Iowa, affiliated with the Avera System of Sioux Falls, South Dakota and is a member of the Iowa and American Hospital Associations.Pre-employment drug screen, background check, and employee health review including required immunizations are required. FVH participates in E-Verify.Floyd Valley Healthcare is an Equal Opportunity Employer committed to providing an environment of opportunities to all applicants and employees without regard to race, color, religion, marital status, age, national origin, physical or mental disability, pregnancy, gender, sexual orientation, gender identity or expression, veteran status, or any other status protected by law.