Nurse Navigator: Prior Authorization & Referrals

Texas A&M University; College Station (TX); On-site; USD 65,000 - 76,000; Full time

Job summary

Texas A&M University’s University Health Services seeks a Registered Nurse II to handle prior authorizations and referrals, ensuring timely access to care for students. The role supports clinic operations, documents in the EMR, and coaches staff on workflows and policies.

The position requires Texas RN licensure, an associates degree, CPR certification, and at least two years of nursing experience, with preferred Bachelor’s in Nursing.

Qualifications

• Education & Experience: Associate Degree in Nursing.
• Two years of experience as a Registered Nurse.
• Must be licensed by the State of Texas as a Registered Nurse.
• CPR certification.

Responsibilities

• Reviews and processes prior authorizations for medications, radiology procedures, and specialty services.
• Navigates payer policies including step therapy, quantity limits, and drug lists.
• Assist patients/providers in applying for patient assistance programs or financial aid.
• Facilitate peer-to-peer reviews with payers when pre-authorizations are denied.
• Collaborate with providers to gather clinical documentation and address denials or escalations.
• Track status of authorizations and manage related communications with patients and staff.
• Coordinate external referrals to specialty providers and ensure timely submission.
• Educate patients on referral processes, coverage details, and treatment plans.
• Document clinical and administrative activities in the EMR.

Skills

Insurance guidelines understanding

Prior authorization knowledge

Care coordination

Clinical documentation review

Communication skills

Multitasking

HIPAA/FERPA awareness

Education

Associate Degree in Nursing

Bachelor's degree in Nursing

Tools

Electronic Medical Record systems

Payer portals

Job description

Texas A&M University’s University Health Services seeks a Registered Nurse II to handle prior authorizations and referrals, ensuring timely access to care for students. The role supports clinic operations, documents in the EMR, and coaches staff on workflows and policies.

The position requires Texas RN licensure, an associates degree, CPR certification, and at least two years of nursing experience, with preferred Bachelor’s in Nursing.